Supported
Employment
Building
Your Program
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
www.samhsa.gov
Supported
Employment
Building
Your Program
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
Acknowledgments
This document was produced for the Substance Abuse and Mental Health Services Administration
(SAMHSA), by the New Hampshire-Dartmouth Psychiatric Research Center under contract number
280-00-8049 with Westat under contract number 270-03-6005, with SAMHSA, U.S. Department
of Health and Human Services (HHS). Neal Brown, M.P.A., and Crystal Blyler, Ph.D., served as
the Government Project Officers.
Disclaimer
The views, opinions, and content of this publication are those of the authors and contributors and
do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services
(CMHS), SAMHSA, or HHS.
Public Domain Notice
All material appearing in this document is in the public domain and may be reproduced
or copied without permission from SAMHSA. Citation of the source is appreciated. However,
this publication may not be reproduced or distributed for a fee without the specific, written
authorization from the Office of Communications, SAMHSA, HHS.
Electronic Access and Copies of Publication
This publication may be downloaded or ordered at www.samhsa.gov/shin. Or, please call
SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) (English
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Recommended Citation
Substance Abuse and Mental Health Services Administration. Supported Employment: Building
Your Program. DHHS Pub. No. SMA-08-4364, Rockville, MD: Center for Mental Health Services,
Substance Abuse and Mental Health Services Administration, U.S. Department of Health and
Human Services, 2009.
Originating Office
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road
Rockville, MD 20857
DHHS Publication No. SMA-08-4364
Printed 2009
Supported
Employment
Building Your Program
Building Your Program is intended to help mental health authorities,
agency administrators, and Supported Employment (SE) leaders think
through and develop the structure of SE programs. The first part of
this booklet gives you background information about the SE model.
This section is followed by specific information about your role in
implementing and sustaining your SE program. Although you will
work closely together to build SE programs, for ease, we separated
tips into two sections:
n Tips for Mental Health Authorities; and
n Tips for Agency Administrators and SE Leaders.
In preparing this information, we could think of no one better
to advise you than people who have worked successfully with
SE programs. Therefore, we based the information in this booklet
on the experience of veteran SE leaders and administrators.
For references, see the booklet The Evidence.
This KIT is part of a series of Evidence-Based Practices KITs created
by the Center for Mental Health Services, Substance Abuse and
Mental Health Services Administration, U.S. Department of Health
and Human Services.
This booklet is part of the Supported Employment KIT that includes
a DVD, CD-ROM, and seven booklets:
How to Use the Evidence-Based Practices KITs
Getting Started with Evidence-Based Practices
Building Your Program
Training Frontline Staff
Evaluating Your Program
The Evidence
Using Multimedia to Introduce Your EBP
Building Your Program 3 What Is Supported Employment
Building Your Program
What Is Supported Employment?
People with serious mental illnesses have
many strengths, talents, and abilities that
are often overlooked, including the ability
and motivation to work. Research has
shown the following:
n About 70 percent of adults with serious
mental illnesses desire work (Mueser
et al., 2001; Rogers et al., 2001).
n Consumers and families consistently
identify finding and keeping jobs as a
top priority.
n Approximately 60 percent of consumers
can be successful at working when using
SE services (Bond et al., 2001).
Supported Employment (SE) is an
approach to vocational rehabilitation
for people with serious mental illnesses
that emphasizes helping them obtain
competitive work in the community
and providing the supports necessary
to ensure their success in the workplace.
SE programs help consumers find jobs
that pay competitive wages in integrated
settings (i.e., with other people who
don’t necessarily have disabilities)
in the community.
The overriding philosophy of SE is the
belief that every person with a serious
mental illness is capable of working
competitively in the community if the
right kind of job and work environment
can be found. Rather than trying to
sculpt consumers into becoming “perfect
workers” through extensive prevocational
assessment and training, consumers are
offered help finding and keeping jobs that
capitalize on their personal strengths and
motivation. Thus, the primary goal of SE
is not to change consumers, but to find
a natural “fit” between consumers’
strengths and experiences and jobs
in the community.
What Is Supported Employment 4 Building Your Program
In contrast to other approaches to vocational
rehabilitation, SE de-emphasizes prevocational
assessment and training and puts a premium on
rapid job search and attainment. The job search
is conducted at a pace that is comfortable for
consumers and is not slowed down by any
programming prerequisites.
Individuals with serious mental illnesses differ from
one another in terms of the types of work they prefer,
the nature of the support they want, and the decision
about whether to disclose their mental illness to
employers or coworkers. SE programs respect these
individual preferences and tailor their vocational
services accordingly.
In addition to appreciating the importance of
consumer preferences, SE programs recognize that
most people with serious mental illnesses benefit
from long-term support after successfully getting
a job. Therefore, SE programs avoid imposing
unrealistic time limitations on services, while
focusing on helping consumers become as
independent and self-reliant as possible.
As consumers succeed in working in the community,
their self-perceptions often change, and they view
themselves as workers and contributors to society.
Furthermore, as people in the community see
consumers working, consumers are less stigmatized
for their mental illnesses and they become more
socially accepted.
SE programs are based on a core set of practice
principles. These principles form the foundation
of the program.
Principle 1: Eligibility is based
on consumer choice
All consumers who want to participate in SE
are eligible—no one is excluded. Consumers
who are interested in work are not prevented
from participating in SE, regardless of their
psychiatric diagnosis, symptoms, work history,
Practice Principles
of Supported Employment
n Eligibility is based on consumer choice.
n SE services are integrated with
comprehensive mental health treatment.
n Competitive employment is the goal.
n Personalized benefits counseling is
important.
n Job search starts soon after consumers
express interest in working.
n Follow-along supports are continuous.
n Consumer preferences are important.
or other problems, including substance abuse and
cognitive impairment.
The core philosophy of SE is that all consumers can
work at competitive jobs in the community without
prior training, and no one should be excluded from
this opportunity.
SE does not try to bring consumers to some
preconceived standard of “work readiness” before
they seek employment. Consumers are “work ready”
when they say they want to work. Research shows
that symptoms, substance abuse, and other
consumer factors are not strong and consistent
predictors of work when consumers receive
assistance from an SE program. Therefore, no
justification exists for excluding consumers who
are interested in working from SE programs.
Principle 2: SE services are integrated with
comprehensive mental health treatment
Closely coordinating SE services with other mental
health rehabilitation and clinical treatment ensures
that all mental health practitioners (not just
employment specialists) support consumers’
vocational goals. For this reason, it is important that
Building Your Program 5 What Is Supported Employment
SE staff participate regularly in clinical treatment
team meetings.
Participating in team meetings gives you a vehicle
to discuss clinical and rehabilitation issues that are
relevant to work, including the following:
n Medication side effects;
n Persistent symptoms (e.g., hallucinations);
n Cognitive difficulties; or
n Other rehabilitation needs (e.g., skills training
to improve ability to socialize with co-workers
or self-assertion skills).
Moreover, regular contact with team members
(phone or face-to-face meetings) also allows you
to help consumers achieve vocational goals.
Principle 3: Competitive employment
is the goal
SE staff help consumers obtain competitive jobs.
n Competitive jobs are part-time or full-time jobs
that exist in the open labor market and pay at
least a minimum wage.
n They are jobs that anyone could have regardless
of their disability status.
Competitive jobs are not jobs that are set aside
for people with disabilities. The wage should not
be less than the wage (and level of benefits) paid
for the same work performed by people who do
not have a mental illness.
Competitive work is valued for several reasons:
n Consumers express a strong preference for
competitive work over jobs that are set aside
for consumers.
Consumers want to work in
community settings.
n Competitive work promotes integrating
consumers into the community.
Involving
consumers in normal activities reduces the stigma
of mental illness.
n Consumers’ self-esteem often improves.
As consumers see that they are able to work
competitively, that their work is valued, and that
they can contribute to society, some consumers
experience improvements in symptoms and
self-esteem.
Historically, many vocational programs have placed
consumers into noncompetitive jobs, often paying
subminimum wages, with only rare progression into
competitive employment. Experience shows that
consumers can successfully work at competitive
jobs without previously participating in training
programs or noncompetitive job experiences.
Principle 4: Personalized benefits counseling
is important
Fear of losing benefits (e.g., Social Security and
health insurance) is a major reason that consumers
may not seek employment. For this reason, it is
vital that consumers who are interested in working
obtain accurate information to guide their decisions
about work.
While employment specialists should be able to
communicate basic information about the impact
of work on consumers’ benefits, all consumers
should have access to benefits counseling when
they start SE services and when changes occur
in their work status.
Principle 5: Job search starts soon after
consumers express interest in working
Employment specialists are directed to help
consumers explore job opportunities within one
month after they start the SE program. Rapid job
search helps engage consumers in SE services and
takes advantage of consumers’ current motivation.
Studies show that fewer consumers obtain
employment when the job search is delayed by
prevocational preparations and requirements.
For this reason, it is against SE principles to require
What Is Supported Employment 6 Building Your Program
extensive pre-employment assessment and training
or intermediate work experiences (like prevocational
work units, transitional employment positions,
or sheltered workshops).
Principle 6: Follow-along supports
are continuous
Some consumers struggle with symptoms that
change or persist over time, so their optimal
treatment and rehabilitation require a long-term
commitment. For this reason, despite their
vocational success, consumers who receive SE
services are never terminated unless they directly
request it. Follow-along supports are provided
to consumers on a time-unlimited basis.
While follow-along supports are continuous,
for many consumers the extent of support
gradually decreases over time. In fact, the goal
for employment specialists is to provide support
and assistance while helping consumers
become independent.
Principle 7: Consumer preferences
are important
Consumers who obtain work that they find
interesting tend to have higher levels of satisfaction
with their jobs and longer job tenures. For this
reason, consumers’ preferences guide all phases of
SE services. Honoring consumers’ preferences is
critical in helping them pursue their vocational goals.
How do we know that
Supported Employment
is effective?
The SE model has been the most extensively
studied model of vocational rehabilitation for
people with serious mental illnesses. Ample
evidence supports its effectiveness. A recent review
of 17 studies involving employment programs
consistently demonstrated that SE programs
showed significant advantages over traditional
approaches. Across these studies, 58 percent of
consumers who were in SE obtained competitive
employment compared to 21 percent in traditional
programs (Bond et al., 2001).
The SE model has been found to produce better
vocational outcomes than the comparison programs,
such as prevocational programming, sheltered work,
and transitional employment. Specifically,
consumers in SE programs were more successful
in achieving these goals:
n Obtaining competitive work;
n Working more hours; and
n Earning higher wages (Bond et al., 2001).
Some research shows that when consumers succeed
in finding competitive work, improvements may
occur in symptoms, self-esteem, and satisfaction
with finances (Bond et al, 2001; Mueser et al.,
1997). Most consumers in SE programs who obtain
employment work part-time and are able to keep
their benefits (i.e., Social Security payments, health
insurance). Work often becomes a meaningful part
of their lives.
Building Your Program 7 What Is Supported Employment
No evidence of negative effects
Practitioners, consumers, and family members are
sometimes concerned that competitive work
will be
a stressful experience that may increase the chances
of relapses and rehospitalizations. However, the
research on SE has consistently found that no
negative effects relate to participating in an SE
program. Specifically, consumers who participate
in SE programs do not experience more severe
symptoms or higher levels of distress, nor do they
require more intensive psychiatric treatment such
as emergency room visits or psychiatric
hospitalizations (Bond et al., 2001).
Who benefits most from
Supported Employment?
Research shows that consumer factors do not
predict better employment outcomes. Specifically,
employment success has not been linked to any of
the following:
n Diagnosis;
n Symptomatology;
n Age;
n Gender;
n Disability status;
n Prior hospitalization;
n Education; or
n Co-occurring condition of substance use
(Bond et al, 2001).
Although work history predicts better employment
outcomes, SE remains more effective than
traditional vocational services for consumers with
both good and poor work histories. Consequently,
we speculate that the professional assistance that
SE programs provide at every stage of the
employment process compensates for consumer
deficits in a way that less assertive vocational
rehabilitation approaches do not.
Some consumer factors have not been
systematically examined in the literature.
For
example, few studies research the effect
of employment services for people with serious
mental illnesses who are homeless. However, Work
as a Priority (Shaheen, Williams, & Dennis, 2003)
addresses the need for employment services to be
coordinated with housing and other services for
this population.
The majority of studies were conducted in settings
with significant numbers of Caucasian, African
American, and Latino consumers (Bond et al.,
2001). Although more replications are needed, all
the evidence to date suggests that the effectiveness
of SE compared to traditional vocational services
generalizes to both the African American and
Latino populations.
Further research is needed to determine whether
SE is equally effective across all ethnic groups.
However, anecdotally, we know that culture and
language pose significant barriers to providing SE
in some populations.
Where should Supported Employment
be provided?
Community characteristics do not appear to impose
a major barrier to implementing an SE program.
SE has been successfully implemented in both very
urban and very rural settings as well as in mid-sized
cities in many different states.
Nearly all research on the effectiveness of SE has
been conducted in community mental health
centers. The extent to which SE can be successfully
adapted to other types of agencies is the subject of
current research, but no strong conclusions can be
drawn now.
What Is Supported Employment 8 Building Your Program
Is Supported Employment cost-effective?
Only limited research has examined the cost of
providing SE services. This research shows that
when an SE program is added to an existing
psychiatric rehabilitation program, overall costs
of services (that is, the combined treatment and
employment program costs) increase. However,
when an SE program replaces another rehabilitation
program—such as a day treatment program—
the overall treatment costs remain the same.
Assuming a caseload of about 18 consumers per
employment specialist, the cost of SE services
typically ranges between $2,000 and $3,000 per
consumer per year (Clark, 1998; Kregel et al., 2000).
SE programs may either increase overall treatment
costs or not affect treatment costs, depending on
whether the services are added or substituted for
another service in a rehabilitation program.
In summary, many mental health systems and
agencies are confronted with the challenge of
meeting the needs of consumers in an environment
of limited resources. The SE model, an evidence-
based practice, is one of the most effective service
strategies available, demonstrating consistent,
positive outcomes for consumers.
Building Your Program 9 Tips for Mental Health Authorities
Building Your Program
Tips for Mental Health Authorities
Successfully implementing evidence-based practices requires the leadership
and involvement of mental health authorities. This section discusses why
you should be involved in SE implementation and the types of activities that
mental health authorities typically undertake.
Why should you be
interested in Supported
Employment?
The Supported Employment (SE) KIT
presents public mental health authorities
with a unique opportunity to improve
clinical services for adults with serious
mental illnesses. Research about service
systems has evolved to a point where it can
identify a cluster of practices that
demonstrate a consistent, positive impact on
the lives of consumers. This KIT represents
one of those evidence-based practices.
The SE KIT makes it possible to give
you this evidence-based practice in a
comprehensive and easy-to-use format.
Can SE make a difference?
Whenever new programs come along,
administrators have to ask whether it is
worth it to reorganize: Is the new program
really going to make a difference?
When it comes to SE, extensive research
shows that the answer is, “
Yes.” Most
Tips for Mental Health Authorities 10 Building Your Program
impressive is the extent to which SE has been
subjected to rigorous research and the consistency
of favorable findings.
Briefly stated, extensive research shows that
consumers in SE programs were more successful
than consumers in other vocational programs in the
following areas:
n Obtaining competitive work;
n Working more hours; and
n Earning higher wages (Bond et al., 2001).
Some research shows that when consumers succeed
in finding competitive work, improvements may
occur in symptoms, self-esteem, and satisfaction with
finances (Bond et al., 2001; Mueser et al., 1997).
For more information, see The Evidence in this KIT.
Aren’t we already doing this?
Your mental health system may already provide
vocational programs. While these services share some
characteristics of SE, important distinctions exist.
SE helps consumers obtain competitive work in the
community and provides the supports necessary to
ensure success at the workplace. SE programs help
consumers find jobs that pay competitive wages in
integrated settings (i.e., with others who don’t
necessarily have a disability) in the community.
SE is based on the following principles:
n Eligibility is based on consumer choice;
n SE services are integrated with comprehensive
mental health treatment;
n Competitive employment is the goal;
n Personalized benefits counseling is important;
n Job search starts soon after consumers express
interest in working;
n Follow-along supports are continuous; and
n Consumer preferences are important.
Will SE work in your mental
health system?
The SE model has been adapted in community
mental health agencies in many states. Studies
showing the effectiveness of SE were conducted in
settings that included primarily Caucasian, African
American, and Latino consumers. However, no
evidence suggests that race, gender, geographic
setting, age, education, diagnosis, symptomatology,
disability status, prior hospitalization, or co-
occurring condition of substance abuse are related
to consumers’ ability to benefit from SE services.
How can mental health
authorities support SE?
As you read about Supported Employment, you
may think that it sounds great but unaffordable.
We want to challenge that notion because other
mental health systems with limited resources
are in the process of implementing SE programs
system-wide. These systems have visionaries
who recognized the benefits of providing this
evidence-based practice and who persisted
in overcoming challenges.
Implementing SE must be a consolidated effort by
agency staff, mental health authorities, consumers,
and families. However, for this initiative to be
successful, mental health authorities must lead
and be involved in developing SE programs in
local communities.
Building Your Program 11 Tips for Mental Health Authorities
Be involved in implementing
Supported Employment
Step 1 Create a vision by clearly articulating SE
principles and goals. Designate a staff
person to oversee your SE initiative.
Step 2 Form advisory groups to build support,
plan, and provide feedback for your SE
initiative.
Step 3 Establish program standards that
support implementation. Make
adherence to those standards part
of licensing criteria.
Step 4 Address financial issues and align
incentives to support implementation.
Step 5 Develop a training structure tailored
to the needs of different stakeholders.
Step 6 Monitor SE fidelity and outcomes
to maintain and sustain program
effectiveness.
Create a vision
Agencies commonly set out to implement one
program, but end up with something entirely
different. Sometimes these variations are
intentional, but often they occur for the
following reasons:
n One administration starts an initiative and
another with a different vision and priorities
subsequently assumes leadership;
n The model wasn’t clearly understood to begin
with; or
n The staff drifted back to doing things in a way
that was more familiar and comfortable.
Articulating the vision that people with mental
illnesses can work and experience competitive
employment is essential to successfully
implementing an SE program. Place the SE
initiative in the context of the larger recovery
paradigm. Articulate how SE programs will help
agencies fulfill their mission—assisting consumers
in their recovery process.
To ensure that your vision is clearly articulated,
designate a staff person who has experience
with the SE model to oversee your SE initiative.
Form advisory groups
You can ensure that the SE model is implemented
appropriately if you contractually mandate that
stakeholder advisory groups guide the
implementation initiative. The development of your
SE program can benefit in many ways from forming
an advisory group including these:
n Building internal and external support;
n Generating referrals;
n Increasing program visibility; and
n Advising with ongoing planning efforts.
Consider forming local and state-level advisory
groups and a Business Advisory Council. State-level
advisory groups may include the following:
n Representatives from different state agencies
(department of labor, rehabilitation services
administration or vocational rehabilitation,
Medicaid, and the Social Security Administration)
that would be invested in the initiative;
n Stakeholders from the Chamber of Commerce
or other business associations;
n Leadership from implementing agencies; and
n Representatives from consumer and family state
advocacy organizations.
Involving stakeholders from the Department of
Labor, for example, can lead to collaborating with
One-Stop Career Centers, which seek to provide
integrated employment and training services so that
Tips for Mental Health Authorities 12 Building Your Program
consumers do not need to go from one place
to another to receive information and services.
Involving stakeholders from vocational
rehabilitation can help streamline procedures that
help generate additional revenue for SE programs.
Furthermore, representatives from the Social
Security Administration can help you identify
resources for benefits counseling and routine
training on the impact of work on benefits.
Local advisory groups can serve as liaisons
between the community and participating
mental health agencies. Community stakeholders
with an interest in the success of SE programs
include representatives of the following:
n Local consumer organizations;
n Local family organizations;
n Agency administrators; and
n Local vocational rehabilitation agencies.
Additionally, many communities have found it
helpful to establish a Business Advisory Council
at the local level.
“It has often been said that the employment of people
with disabilities is mostly a matter of opportunity and
support. The quantity and quality of opportunity,
however, depends on how available, interested, and
informed employers are. Furthermore, as studies on
employer views of disability illustrate, the target of the
support should be as much the employer as the job
seeker.” (Luecking, Fabian, & Tilson, 2004).
Forming a Business Advisory Council will allow
you to engage and elicit feedback from local
employers. Use the forum to educate employers
about the benefits of hiring people with mental
illnesses. Inform them of the benefits of a
collaborative working relationship including
the following components:
n A pool of interested and qualified applicants;
n Prescreening of potential applicants to assess
their skills and strengths for available positions;
n Short-term, onsite job coaching to help new
employees become situated;
n Guidance about reasonable accommodations; and
n Information about the Work Opportunities Tax
Credit that reduces employers’ federal income
tax liability.
From the beginning, you need to lead your
advisory groups in understanding and articulating
what SE is and how it is going to be developed in
your mental health service system. For training
materials that you can use to help stakeholders
develop a basic understanding of Supported
Employment, see Using Multimedia to Introduce
Your EBP in this KIT.
Advisory groups should continue to meet well after
your SE program has been established. We suggest
that they meet about once a month for the first
year, once every 2 months for the second year, and
quarterly for the third year. By the second and third
years, advisory groups may help SE programs
sustain high fidelity by assisting with fidelity
evaluations, outcomes monitoring, or translating
evaluation data into steps for continuous quality
improvement. For more information on the role of
advisory groups, see Getting Started with EBPs in
this KIT.
Planning your SE initiative
With a vision firmly in place, the process of
unfolding SE programs across the service system
can begin. Carefully planning this process will help
ensure a successful outcome.
Implementing SE programs first in pilot or
demonstration sites may be useful. Working with
pilot sites can help you manage problems as they
arise and give constituents the opportunity to see
that SE works.
Multiple pilot sites are preferable to just one.
When only one site is used, idiosyncratic things
Building Your Program 13 Tips for Mental Health Authorities
can happen that misrepresent the model. On the
other hand, when systems do a system-wide
“rollout,” it is difficult to adequately train all SE
staff. In that case, system problems that may have
been resolved easily on a smaller scale with a few
SE programs can cause havoc.
Establish program standards
Studies of agencies that have tried to replicate
evidence-based models have found that if agencies
did not achieve positive outcomes, it was often
because they failed to implement all of model’s
components (Becker et al., 2001; Bond & Salyers,
2004). As a mental health authority, you have the
capacity to ensure that the system has incentives to
implement SE. Attention to aligning these
incentives in a positive way (such as attaching
financial incentives to achieving higher competitive
employment rates) is vital to successfully
implementing SE.
States have the authority to adopt regulations that
govern services to consumers. These regulations set
standards for the quality and adequacy of programs,
including criteria that govern these areas:
n Admission and discharge;
n Staffing;
n Service components;
n Assessment and treatment planning;
n Consumer medical records;
n Consumer rights; and
n Supervision and program evaluation.
Support the implementation of SE by explicitly
referencing SE in licensing standards and other
program review documents (for example, grant
applications, contracts, requests for proposals, and
so forth). It is also important to review current
administrative rules and regulations to identify any
barriers to implementing SE. Work closely with
agency administrators to ensure that mental health
authority policies support high-fidelity SE practice.
Address financial issues
Each state is different. In many cases, while your
SE initiative can be mounted with little or no
additional appropriations, it is important to review
funding streams to ensure that they support SE
implementation.
What does SE cost?
The cost of providing SE services varies from state
to state, ranging from $2,000 to $4,000 per
consumer per year (Clark, 1998; Kregel et al.,
2000). The cost figures vary according to many
factors, including the following:
n Severity of disability for consumers served;
n Local wage scales for employment specialists;
n Indirect costs; and
n Costs of clinical services.
How is SE funded?
Funding mechanisms vary from state to state. For
the most part, funds are used from these sources:
n Rehabilitation services administration (or
vocational rehabilitation);
n Division of mental health; and
n Medicaid.
Work with leaders from these state agencies to
develop a mechanism to pool monies that can be
used to reimburse the services of SE programs.
State Medicaid rules may allow reimbursement for
selected SE services. Consider contacting
administrators from other states who have
successfully worked out a plan to gather useful
ideas and strategies.
Tips for Mental Health Authorities 14 Building Your Program
If you determine that additional appropriations
are necessary to fund SE services, consider shifting
resources from services that have not been
scientifically demonstrated to be effective or that
consumers desire less.
Develop a training structure
Agencies who implement evidence-based practices
(EBPs) are often stymied in their efforts because
people misunderstand the model or lack
information. It is important that key stakeholders
(consumers, families, and other essential
community members) and agency-wide staff
develop a basic understanding of SE.
We encourage you to support agency administrators
in their efforts to develop a training structure for
implementing SE.
n The training plan should include basic training
for key community stakeholders, including these
people:
n Consumers;
n Families;
n Employers;
n Mental health authorities; and
n Staff from key community organizations.
n The training plan should also include basic
training for staff at all levels across the agency
and intensive training for employment specialists.
Choose your trainer
You may design an intensive training plan for
employment specialists in several different ways,
but you must first decide who will conduct the
training. SE leaders may facilitate the initial
training for employment specialists by using the
training tools in Training Frontline Staff in this KIT.
Some choose to hire external trainers.
One successful strategy in training employment
specialists entails having new employment
specialists visit an existing, well-functioning,
high-fidelity SE program to observe how the
program works. New employment specialists will
benefit most from this visit if they have a basic
understanding of the SE model.
Once trained, SE leaders and employment
specialists will be able to use the tools in Using
Multimedia to Introduce Your EBP in this KIT
to provide basic training to key stakeholders.
Offer ongoing training and consultation
Throughout the first year of your SE program, we
encourage you to offer SE staff intermittent booster
training sessions. After the first year, consider
establishing an annual state-wide conference on SE.
Routine onsite and telephone consultation is also
important, particularly for SE leaders. Leading an
SE team requires a complex set of administrative
and clinical skills. SE leaders provide direct services
and supervision, which may require a shift in
thinking about consumers’ potentials and about
how colleagues work together.
SE leaders also have administrative responsibilities
such as hiring, preparing administrative reports,
and developing policies and procedures. Perhaps
more important, SE leaders are responsible for
ensuring that the SE program operates with fidelity
to the SE model, including ensuring the quality and
content of staff-consumer interactions.
Only through day-to-day leadership will the SE
model be faithfully carried out. For this reason,
it is very difficult for anyone to grasp everything
that has to be learned in a brief time. Also,
understanding what needs to be done and
translating that understanding into action are
different and equally difficult.
Building Your Program 15 Tips for Mental Health Authorities
For at least the first year a new program is in
operation, SE leaders need someone who is
experienced in SE to provide ongoing consultation
on organizational and clinical issues. Consultation
ranges from integrating SE principles into the
agency’s policies and procedures to case consultation.
Some states develop EBP programs in stages so
that the first employment specialists can help train
those in newly developed programs. Generally, it
takes about a year for staff to feel confident
providing SE, but this can vary depending on how
much structural change is needed. Programs that
are not already team oriented or are reluctant to
accept new models can take longer to change.
It may take 2 to 3 years for an agency to become
sufficiently proficient in the SE model to assume
the added responsibility of training other agencies’
employment specialists. Agencies that have
become SE training sites indicate that involving
their staff in training staff from new SE programs
reinforces SE principles and knowledge of the SE
model. A state- or county-wide coordinator who is
experienced with the SE model can also help new
SE programs through ongoing contact, assessment,
and troubleshooting.
Monitor SE fidelity and outcomes
Providing SE involves incorporating a new program
into the service delivery system. The best way to
protect your investment is to make certain that
agencies actually provide SE services that positively
affect the lives of consumers.
Programs that adhere more closely to the
evidence-based model are more effective.
Adhering to the model is called SE fidelity. The SE
Fidelity Scale measures how well programs follow
key elements of the SE model (Bond et al., 1997).
Studies of evidence-based models tell us that the
higher an agency scores on a fidelity scale, the
greater the likelihood that the agency will achieve
favorable consumer outcomes (Bond & Salyers,
2004). For this reason, it is important to monitor
both SE fidelity and SE outcomes.
As a central part of the initial planning process, you
must address how you will monitor the fidelity and
outcomes of SE programs. Too many excellent
initiatives had positive beginnings and enthusiastic
support but floundered at the end of a year because
they did not plan how they would maintain the SE
program. Monitoring SE fidelity and outcomes on
an ongoing basis is a good way to ensure that your
SE programs will continue to grow and develop.
Consider developing routine supervision and
evaluations of your SE programs. If it is not
possible, use strategies (e.g., rules, contracts,
financial incentives, etc.) to support fidelity and
outcomes monitoring on the local level or within
individual agencies.
The characteristics of an SE program that would
have a perfect score on the SE Fidelity Scale are
shown on the next page. For the entire SE Fidelity
Scale, see Evaluating Your Program in this KIT.
Tips for Mental Health Authorities 16 Building Your Program
Characteristics of an SE program that would have a perfect score on the
SE Fidelity Scale
Caseload
Employment specialists manage caseloads of up to 25 consumers.
Vocational services staff
Employment specialists provide only vocational services.
Vocational generalists
Each employment specialist carries out all phases of vocational service.
Integration of rehabilitation
with mental health treatment
Employment specialists are part of the mental health treatment teams
with shared decisionmaking.
Vocational unit
Employment specialists function as a unit.
Zero-exclusion criteria
There are no eligibility requirements to enter the SE program.
Ongoing, work-based assessment
Vocational assessment is an ongoing process.
Rapid search for competitive jobs
The search for competitive jobs occurs rapidly after program entry.
Individualized job search
Employer contacts are based on consumers’ job preferences.
Diversity of jobs developed
Employment specialists provide job options that are in different settings.
Permanence of jobs developed
Employment specialists provide competitive job options that have
permanent status.
Jobs as transitions
Employment specialists help consumers end jobs when appropriate and
then find new jobs.
Follow-along supports
Individualized, follow-along supports are provided to employers and
consumers on a time-unlimited basis.
Community-based services
Vocational services are provided in community settings.
Assertive engagement
and outreach
Employment specialists make multiple contacts with consumers as part
of initial engagement and at least monthly on a time-unlimited basis
when consumers stop attending vocational services.
Building Your Program 17 Tips for Agency Administrators and SE Leaders
Building Your Program
Tips for Agency Administrators and Supported
Employment Leaders
Whether your agency is interested in enhancing an existing program or developing
a new program, you will need a broad range of activities to successfully implement
Supported Employment (SE). This section outlines the range of implementation
activities in which agency administrators and SE leaders are often involved.
Recruit your SE staff
SE programs consist of an SE leader,
two or more employment specialists, and
a benefits counselor, depending on the
number of consumers that the agency plans
to serve.
SE leader and employment specialist
positions are typically full time. Part-time
positions generally do not work out well.
As part of their jobs, both employment
specialists and SE leaders juggle a variety
of tasks and must be dedicated to the work,
which is difficult to do on a part-time basis.
In the SE model, SE leaders and
employment specialists provide only
vocational services. They do not supervise
or act as case managers. When they carry
out dual responsibilities, they tend to
lose their focus on employment and are
less effective. Therefore, staff should be
dedicated completely to SE.
Tips for Agency Administrators and SE Leaders 18 Building Your Program
Choose an SE leader
It is important to hire or designate a leader for
your SE program. We suggest that SE leaders are
full-time employees whose time is 100 percent
dedicated to the SE program.
SE leaders are often mid-level managers who have
the authority to make or suggest administrative
changes within the agency. Successful SE leaders
have both administrative and clinical skills. As part
of their administrative responsibilities, SE leaders
undertake the following:
n Hire and train employment specialists;
n Develop SE policies and procedures;
n Act as a liaison with other agency coordinators;
n Manage SE referrals;
n Monitor the program’s fidelity to the SE model;
and
n Oversee various other quality control and
financial responsibilities.
As part of their clinical responsibilities, SE leaders
undertake the following:
n Provide SE services;
n Provide weekly group supervision;
n Provide individual supervision as needed; and
n Give program feedback to the SE team.
Below is an example of the SE leader’s job
description. Since SE leaders must have an active
role in setting up the structures and processes
needed to support the SE team, we encourage you
to make the KIT available to candidates during the
hiring process so that they will understand what
they must do.
Select the best employment specialists
The most important characteristic of a good
employment specialist is the belief that people with
serious mental illnesses who are interested in
Sample job description for Supported Employment leaders
Overall function
Oversees the SE program by supervising employment specialists and being the administrative
liaison to other coordinators within the mental health agency
Responsibilities
n Accepts SE referrals and assigns employment specialists to work one-on-one with consumers
n Supervises SE team weekly using case examples and following SE principles and procedures
n Individually supervises employment specialists as needed
n Acts as liaison to other department coordinators in the mental health
agency
n Monitors and ensures the integration of the employment specialists with treatment teams
n Provides SE services to small caseload (e.g., fewer than 15 people)
Qualifications
Master’s degree in rehabilitation counseling or related field
Previous experience as an employment specialist helping people with serious mental illnesses
obtain and sustain competitive employment is desired
Previous supervisory experience is desired
Building Your Program 19 Tips for Agency Administrators and SE Leaders
working can obtain competitive jobs and sustain
them, if the job is a good match and the right
supports are put in place. Some agencies hire
employment specialists who go for months without
helping consumers find work.
The SE leader may hear the employment specialist
say that consumers are not motivated, employers
will not hire people with mental illnesses, or high
unemployment is the problem. In such cases,
employment specialists’ doubts may impede
consumers’ success. To effectively support
consumers in obtaining and sustaining employment,
employment specialists must wholeheartedly
believe that consumers can work.
Success as an employment specialist appears to
have less to do with academic credentials and more
to do with personal style and philosophy. Positive,
high-energy, and enthusiastic people who have a
“can do” attitude tend to do well.
As you can see from the sample job description
on the next page, the employment specialists’ tasks
are as varied as the skills needed to complete them.
Employment specialists must have these skills:
n Counseling skills;
n Skills to engage consumers and employers;
n Business skills to conduct job searches; and
n Strong interpersonal skills.
Good candidates generally come either from the
business community or from positions in vocational
rehabilitation services where they have worked
very closely with employers. Applicants who have
training and experience in vocational programs
that use a step-wise approach may not be good
candidates since they may reject SE principles
such as rapid job search.
Desired qualifications are as follows:
n Knowledge of serious mental illnesses (including
treatment, medication, and the impact of mental
illnesses on vocational functioning);
n Ability to identify consumers’ interests, strengths,
skills, abilities, and unique set of challenges and
match them with jobs;
n Ability to identify and arrange long-term supports
to help consumers keep jobs;
n Ability to advocate effectively for consumers
with team members and employers;
n General knowledge and experience
in job development and marketing;
n Demonstrated ability to relate positively
with employers in the community; and
n Working knowledge of a broad range
of occupations and jobs.
Successful employment specialists are typically
task-oriented people who are outgoing and assertive
and who have the ability to engage all different
types of people, including consumers, family
members, team members, and employers.
Employment specialists must also be able to work
both independently and as team members—
providing cross-coverage for SE team members
and participating in group supervision.
Employment specialists must also enjoy working
in the community. Employment specialists spend
more than 60 percent of the time in the community
developing jobs and providing support to consumers
and employers. For this reason, employment
specialists should enjoy knocking on doors, talking
to people in their community, putting people and
ideas together, and doing whatever it takes to help
consumers reach their vocational goals.
Hiring employment specialists who have lived
in the community and are familiar with the local
businesses is helpful for conducting successful
job searches.
People who become good employment specialists
do not necessarily come to the job with all the
above qualifications. Some people can acquire
knowledge and skills on the job as long as they
are smart and eager to learn. Training and good
supervision — along with the lessons learned
Tips for Agency Administrators and SE Leaders 20 Building Your Program
Sample job description for employment specialists
Overall function
Carries out SE services by helping consumers obtain and sustain employment that is consistent
with their vocational goals and recovery
Responsibilities
n Engages consumers and establishes trusting, collaborative relationships directed toward the
goal of competitive employment in integrated job settings
n
n
n
n
n
n
n
n
n
Assesses consumers’ vocational functioning on ongoing basis
Following SE principles and procedures, helps consumers in job development and job search
activities directed toward positions that are consistent with consumers’ needs and interests
Provides individualized, time-unlimited, follow-along services to help consumers sustain
employment
Based on agreement with consumers, provides education and support to employers, which
may include negotiating job accommodations and follow-along contact with employers
Provides outreach services to consumers, as necessary, when they appear to disengage from SE
services. If necessary, maintains some contact with consumers even without a vocational focus
to sustain engagement
Meets regularly with treatment team members to coordinate and integrate vocational services
into mental health treatment
Draws up individual employment plans with consumers, case managers, and other treatment
team providers and updates the plans quarterly
Spends at least 60 percent of direct service time in the community to engage and support
consumers, family members, and employers
Carries out other duties as assigned
Qualifications
Education and experience equivalent to undergraduate degree in mental health or social services,
business, personnel management, or vocational services
Experience working with people with serious mental illnesses, experience with vocational services,
and knowledge of the work world are preferred
Ability to work as an effective team player is essential
through day-to-day experience — help most
employment specialists develop the skills and
confidence to do a good job.
Consider hiring a benefits counselor
Historically, practitioners encouraged consumers to
limit working to protect their benefits. However, for
most consumers a life spent on benefits means a life
spent in poverty. In most cases, consumers are
better off financially if they work and take
advantage of available work incentives. For this
reason, it is important that consumers have accurate
information to make informed choices.
In general, employment specialists and other
practitioners may know that rules govern benefits
and earned income. But in most cases, their
information is not comprehensive. The rules are
complicated and periodically adjusted, making it
difficult to keep up to date with the information.
This is why many agencies create benefits specialist
positions. Benefits specialists have comprehensive
information about benefits and work incentives.
They meet with consumers who are considering
going to work to review their benefits and project
how work will affect them. They also provide
personalized benefits planning to help consumers
manage their benefits and health care coverage
as they work more and increase their earnings.
Building Your Program 21 Tips for Agency Administrators and SE Leaders
Some evidence shows that consumers who received
benefits counseling tend to earn more money than
consumers who did not.
If your agency is unable to hire a benefits specialist,
look for other ways that consumers can access
benefits counseling. For example, the Social
Security Administration funds benefits counseling
services in all 50 states through the Work Incentives
Planning and Assistane (WIPA) projects. Contact
your state WIPA project for more information.
Visit
DisabilityInfo.gov or ask your mental health
authority for other resources in your area.
Reflect your community’s cultural diversity
SE teams should reflect the cultural diversity
of the communities in which they operate. More
important, employment specialists must be aware
of and sensitive to cultural differences and
consumer preferences. SE teams should reflect the
cultural diversity of the communities in which they
provide services, and they should include bilingual
employment specialists as needed.
Having a balance of male and female employment
specialists may also be helpful. Your SE program
must also have resources available to allow
employment specialists to work with consumers
who have hearing and visual impairments.
Consider these hiring tips
You should thoroughly check references for job
candidates. The best predictor of work performance
is likely to be candidates’ performance in previous
jobs, particularly jobs that required some of the
same skills and personal qualities that are desirable
for employment specialists. The SE leader should
talk to previous supervisors, ask in detail about
candidates’ previous work responsibilities and
performance, and seek opinions about their
capabilities. If candidates have had little experience
in the mental health field or have just finished
school, you can gather valuable information from
field supervisors, training mentors, and teachers.
Invite all candidates who are being seriously
considered for employment to spend half a day
or more in your SE program so that they can see
employment specialists at work firsthand.
Candidates can then better evaluate how well they
might fit in and be able to make a more informed
decision about taking the job. This visit will also
give employment specialists a chance to talk with
and observe candidates. Ask them to offer their
feedback during the hiring process. This type of
screening may help you weed out people who may
be too authoritarian or patronizing to be
appropriate for an SE program.
Build support for your
SE program
Developing successful SE services depends on
the support and collaboration of a number of
stakeholders. Internally, it is important that your
director and staff across the agency understand
and support the implementation of SE. Your SE
program is more likely to achieve high fidelity if
your agency director is informed and involved
in the implementation process from the start.
It is important that your agency director take the
lead in promoting the SE program and addressing
any misconceptions that consumers cannot work.
Your agency director should articulate internal and
public support for your SE program by telling key
stakeholders that people with mental illnesses can
succeed in competitive employment and that SE
services are linked to positive consumer outcomes.
Emphasize the importance of your SE services by
demonstrating how work helps consumers get on
with life beyond illness to achieve their personal
recovery goals.
Tips for Agency Administrators and SE Leaders 22 Building Your Program
Once your agency director has articulated a clear
vision for implementing SE, bolster internal
support for your SE program by providing basic
information to all agency staff. For more
information, see Develop a Training Plan later
in this booklet.
Form advisory committees
Forming an SE advisory committee is an effective
way to gain the support of key stakeholders for your
SE program. Identify community stakeholders with
an interest in the success of your SE program to
serve on your committee. Committees often
include the following personnel:
n Representatives from your local consumer
organizations;
n Members of your local family organizations;
n Designated vocational rehabilitation counselors;
n Representatives from your local mental health
authority;
n Key agency staff; and
n SE staff.
Consider also establishing a Business Advisory
Council to engage and elicit feedback from local
employers. Use the forum to educate employers
about the benefits of hiring people with disabilities.
Inform them that SE services can provide
the following:
n A pool of interested and qualified applicants;
n Prescreening of potential applicants to assess
their skills and strengths for available positions;
n Short-term, onsite job coaching to help new
employees become situated;
n Guidance about reasonable accommodations; and
n Information about the Work Opportunities Tax
Credit that reduces their federal income tax
liability.
To start, your mental health authority
representative or agency director should voice
support for the SE initiative. Next, basic training
should be provided to help advisory group
members understand the SE model. Once
established, advisory groups may help implement
SE in a variety of ways. For more information,
see Getting Started with Evidence-Based Practices
in this KIT.
Sustain support for your SE program
Building support for your SE program should
be an ongoing effort. Once your SE program is
operational, find ways to recognize and reward
the achievements of SE staff and consumers. For
example, organize meetings with key stakeholders
where consumers share employment success stories
and administrators highlight staff achievements.
Another option is to sponsor an employment
banquet to celebrate the program’s
accomplishments with consumers, family members,
employers, and agency staff members. Banquets
are particularly helpful if a wide array of
stakeholders (such as physicians, administrators,
and key public officials) attend.
Your agency director and SE leader should meet
regularly to review program evaluation data,
discuss roadblocks, and plan ways to improve your
SE program.
Building Your Program 23 Tips for Agency Administrators and SE Leaders
Develop a collaborative relationship with
your local vocational rehabilitation agency
Many agencies collaborate with the rehabilitation
services administration (also known as vocational
rehabilitation) to provide SE services. Vocational
rehabilitation and mental health agencies share the
goal of helping people with disabilities return to
work and increase their independence.
Historically, the two state systems have not always
collaborated in a way that provides seamless and
coordinated services for consumers. If this is the
case in your state, your SE initiative presents
a new opportunity to build an effective working
relationship with your local vocational
rehabilitation agency.
Collaborations may bring added resources and
services. For example, vocational rehabilitation
counselors may provide the following:
n Training;
n Additional job shadowing;
n Job-related equipment and supplies;
n School tuition;
n Planning assistance; or
n Assistance with placement and support.
Work with your agency director and mental health
authority representative to engage local and state
vocational rehabilitation representatives early in the
implementation process. Share information about
SE and invite them to participate in your SE
advisory group.
Understanding the guidelines and practices of each
other’s systems will close the gaps that have formed
barriers and create new ways of working together
to provide more effective services for consumers.
Agencies with effective relationships with
their local vocational rehabilitation agency
communicate regularly with designated vocational
rehabilitation counselors. Often counselors are
included on consumers’ treatment teams. Other
SE programs also arrange for counselors to meet
weekly or biweekly with consumers at the mental
health agency.
In summary, building support from internal staff
and key community stakeholders for your SE
initiative is essential to implementing effective
SE services.
Agency directors can lead this effort
n Articulating clear support for the SE
program to internal staff and key
community stakeholders
n Attending some SE trainings, supervision,
and advisory group meetings
n Meeting monthly with the SE leader
to address roadblocks to providing SE
n Facilitating ongoing planning and program
improvement efforts
n Engaging local and state vocational
rehabilitation agency representatives
Tips for Agency Administrators and SE Leaders 24 Building Your Program
Develop effective policies
and procedures
Starting a new SE program means developing
policies and procedures that support the activities
of the SE model.
impairments or because they are not “ready to
work.” According to SE principles, all consumers
who want to work are eligible—no one is excluded.
Develop a simple referral process using minimal
eligibility criteria. Typically, SE leaders receive all
referrals, review them, and pair consumers with
employment specialists. This process should occur
rapidly. In the SE model, employment specialists
and consumers meet within one week after the
referral. Engaging consumers in SE services quickly
has been found to be a key component in providing
effective SE services.
Once you have developed your referral process,
integrate it into your intake procedures so that
consumers who are new to your agency know that
SE services are available. SE staff and intake
specialists should review how to explain the SE
program to consumers in a way that helps them
make informed decisions about accepting services.
Generating referrals takes some planning and
effort at first. All of the activities designed to
build support for your program (described in
this booklet) can also help you generate referrals.
Acquaint a variety of stakeholders with your
referral process including these individuals:
n All staff in your agency;
n SE advisory committee members; and
n Consumers in your agency.
The key to generating referrals is to get the word
out. Elicit ideas from your SE advisory group
and staff for engaging consumers and increasing
referrals. On the next page is an example of an
SE referral form that you may use as a basis for
creating your own.
What policies and procedures
should cover
n Admission criteria
n Discharge criteria
n Staffing criteria
n Program organization and communication
n Assessment and treatment planning criteria
n Consumer records requirements
n Consumers’ rights
n Program and team member
performance evaluation
Develop admission criteria
When you develop your SE admission criteria,
integrate the principles of the SE model. The SE
model includes specific criteria that you should
integrate into your admissions and discharge
criteria. The SE model indicates that services
should be accessible to as many consumers as
possible. Consumers should not be excluded from
SE services because of substance abuse or cognitive
Building Your Program 25 Tips for Agency Administrators and SE Leaders
Sample Supported Employment Program Referral Form
Consumer’s name
Consumer’s I.D.
number
Telephone (______) ______ --__________ Date of referral ____/___/_____
Referral source
Date referral
was received ____/___/_____
Assigned to
Date of first meeting with
employment specialist ___/___/______ Date Employment Plan was completed ____/___/_____
Job suggestions and
recommendations for
work environments
Medications and side
effects, if any, that
might interfere with
work such as shaking,
memory impairment,
drowsiness, etc.
Substance use
(substances, current use)
Criminal history (if any)
Any information you
feel would help this
person reach his or her
employment goals
Tips for Agency Administrators and SE Leaders 26 Building Your Program
Develop discharge criteria
When you develop your SE discharge criteria,
integrate the principles from the SE model. Some
consumers struggle with symptoms that persist over
time, so their optimal treatment and rehabilitation
require a long-term commitment. For this reason,
despite their vocational success, consumers who
receive SE services are never terminated unless
they directly request it. In your SE discharge
policies and procedures specify that follow-along
supports should be provided to consumers on a
time-unlimited basis.
Establish staffing criteria
Your SE policies and procedures should also specify
the staffing criteria for your program. Generally, SE
teams should plan on having an employment
specialist-to-consumer ratio of no more than 25
consumers per employment specialist.
To figure your program capacity:
Total number of employment specialists = 2 FTE
Maximum number of consumers per practitioner = 25:1
2 FTE
X 25 consumers per employment specialists
50 maximum program capacity
You may consider decreasing this ratio in the first
year of implementation. Make sure your staff-to-
consumer ratio is small enough to ensure that all
employment specialists learn how to practice high-
fidelity SE. No matter how well a team is organized
or how competent employment specialists may be,
the team will be unable to achieve high-fidelity
practice if its caseload is too large during the
first year.
Once your program is fully operational, continue
to monitor the staff-to-consumer ratio. If you
exceed the maximum number of consumers,
work effectiveness will break down and
employment specialists will react to crises
(or the imminent threat of crises) rather than help
consumers take proactive steps towards achieving
their vocational goals.
Create useful job descriptions
Include clear and useful job descriptions within
the staffing criteria of your SE policies. For job
applicants, a good position description clarifies
whether a particular position matches their skills
and expectations. Develop task-specific position
descriptions, outline the main task categories, and
detail specific duties.
Clear job descriptions allow SE leaders to effectively
supervise new employees and also allow employees
to focus on the basic elements of their jobs.
Discuss program organization and
communication
SE policies and procedures should include criteria
for how the SE program is organized and how
employment specialists relate to one another. To be
effective, employment specialists must be able to
work both independently and as team members.
As members of the SE team, employment
specialists should communicate regularly and
provide cross-coverage for consumers.
Employment specialists should also attend weekly
SE group supervisory meetings. These meetings
give employment specialists the opportunity to
discuss and problem-solve consumer cases.
Building Your Program 27 Tips for Agency Administrators and SE Leaders
In addition to group supervision, employment
specialists should meet weekly to share job leads,
which are often obtained through networking.
Instruct employment specialists to keep an
employer log to track the businesses they contact.
In this meeting, SE staff can review the employer log
and plan ways to build more employer relationships.
Your SE policies should also outline clear
procedures for how SE staff will communicate
with other treatment team members. SE services
are most effective in an environment where
employment specialists are part of a clinical
treatment team that communicates frequently
and meets weekly. Close coordination of SE
services with other mental health rehabilitation
and treatment ensures that everyone involved
(not just employment specialists) provides services
that support consumers’ vocational goals.
Employment specialists can work on several
multidisciplinary treatment teams. However, if they
work on more than two teams, they generally have
to spend too much time in meetings or don’t have
the chance to adequately communicate with other
team members.
Treatment teams are organized differently from one
agency to the next. Some teams quickly run through
the list of consumers they serve, communicating
with team members about employment and clinical
issues. Other treatment teams just share
information about crisis situations. In the latter kind
of meeting, time must be set aside and guarded by
the team leader for proactive communication about
employment. Additionally, employment specialists
must actively participate and speak during
treatment team meetings.
Integrating SE services with mental health
treatment may be more challenging if employment
specialists and other team members work for
different agencies. Seek creative solutions to ensure
that employment specialists are able to meet weekly
and communicate frequently with consumers’
clinical treatment teams.
Involve significant others
SE policies and procedures should encourage and
facilitate involving family and other supporters to
help consumers increase their natural supports.
Instruct employment specialists to ask consumers
to identify a family member or other supporter
whom they would like to involve in SE services.
Involving family or other supporters helps
employment specialists to do the following:
n Clarify consumer interests, strengths, skills,
and abilities;
n Identify job leads;
n Determine whether a potential job is a good
match;
n Identify challenges consumers are facing on the
job; and
n Provide ongoing support to working consumers.
With consumers’ permission, family or other
supporters may join meetings with the consumer
and employment specialist, meet or talk with the
employment specialist alone, or attend treatment
team meetings.
Tips for Agency Administrators and SE Leaders 28 Building Your Program
Develop assessment and treatment
planning criteria
Outline procedures for assessment and treatment
planning in your SE policies and procedures.
In general, SE staff use two tools to assess and
track consumers’ goals and progress:
n Vocational Profile; and
n Individual Employment Plan.
Employment specialists and consumers complete
the Vocational Profile within a few weeks after
consumers are referred to the SE program.
Information collected on the Vocational Profile
helps employment specialists begin the job
search rapidly.
Starting the job search within one month has been
found to be a key component of providing effective
SE services. Procedures for completing the
Vocational Profile should specify that the form
does not need to be fully completed for the job
search to begin. In others words, the job search
should not be delayed in order to complete
the form. Employment specialists should add
information to the form as it becomes available.
Procedures should also instruct employment
specialists to collect information from a variety
of sources:
n The consumer;
n The treatment team;
n The consumer’s record; and
n With permission, the consumer’s family members
and previous employers.
On the next several pages are examples of
a Vocational Profile form and an Individual
Employment Plan.
Building Your Program 29 Tips for Agency Administrators and SE Leaders
Sample: Vocational Profile
Vocational Profile
Consumer’s name Consumer’s I.D. number
Completed by Date completed
__/___/___
Work goal
Consumer’s work goal
and life dream for work
What would you say is your
dream job? What kind
of work have you always
wanted to do?
Dream job:
Consumer’s short-term
work goal
What job would you like
to have now?
Job you’d like to have now:
Background
Education
What school did you
attend last?
Last school attended:
What was the highest
grade you completed?
Highest grade completed:
Work history
Most recent job
What was your most
recent job?
Most recent job: _________________________ Job title: __________________
Job started: ____/___/_____ Job ended: ____/___/_____
Number of hours worked per week: _________
What were the job duties? Job duties:
Reason for leaving job
Why did the job end?
Positive experiences
What did you like best
about the job?
Problems on job
What did you not like
about the job?
Tips for Agency Administrators and SE Leaders 30 Building Your Program
Work history continued
Next most recent job
What did you like best
about the job??
Previous job: _________________________ Job title: __________________
Job started: ____/___/_____ Job ended: ____/___/_____
Number of hours worked per week: _________
What were the job duties?
Job duties:
Reason for leaving
the job
Why did the job end?
Note
: Attach resume to
capture additional
work history.
Current adjustment
Diagnosis
Prodromal symptoms
What are the first signs that
you may be experiencing a
symptom flare-up?
First signs of a flare-up:
How would I be able to tell
if you are having a bad day
or not feeling well?
Signs of a bad day:
Coping strategies
What do you do to make
yourself feel better?
Medication management
What medication do you
take and when do you
take it?
Medication: ______________________________ When you take it: _____________
Medication: ______________________________ When you take it: _____________
Medication: ______________________________ When you take it: _____________
Physical health
How would you rate your
physical health?
Excellent
Good
Fair
Poor
Do you have any physical
limitations that might
influence your work? What
are they?
Physical limitations:
Endurance
How many days per week
would you like to work?
How many hours a day?
Most number of days per week: _________
Most number of hours per day: _________
Vocational Profile
Building Your Program 31 Tips for Agency Administrators and SE Leaders
Current adjustment continued
Grooming
Do you have a place to
bathe or shower?
Yes
No
Do you have the clothes
you will need for work?
Yes
No
Interpersonal skills
How well do you get along
with people?
Excellent
Good
Fair
Poor
Work skills
Job-seeking skills
How have you looked for
work in the past?
Specific vocational skills
What skills have you
learned either on the job
or in school?
Aptitude
What kind of work are you
particularly good at?
Interests and daily
routine
What kinds of things do
you like to do?
What is a typical day like
for you?
Motivation and
expectations
What appeals to you about
work?
What do you not like about
work?
Are there things that you
worry about regarding
going back to work?
What do you think work
will do for you personally,
financially, and socially?
Vocational Profile
Tips for Agency Administrators and SE Leaders 32 Building Your Program
Work skills continued
Work habits
How was your attendance
in previous jobs?
What kinds of situations
and tasks cause you to
feel stress?
Support network
Whom do you spend
time with?
Person you spend time with: ________________________ How often: __________
Person you spend time with: ________________________ How often: __________
Person you spend time with: ________________________ How often: __________
How often do you see
or talk to them?
What do they think
about work?
How could they support
your work goals?
Current living situation
Where do you live and
with whom do you live?
Where you live: __________________________________________________________
__________________________________________________________
With whom? __________________________________________________________
__________________________________________________________
Transportation
How would you get
to work?
Substance use
Have you ever used street
drugs or alcohol?
Yes
No
Have other people in your
life been concerned about
your substance use?
Yes
No
Criminal record
Have you ever been
arrested?
Yes
No
Disclosure of mental
illness
Will you be willing to tell
possible employers about
your illness?
Yes
No
Income and benefits
Where does your money
come from?
Where your money comes from: _____________________________________________
_____________________________________________
Vocational Profile
Building Your Program 33 Tips for Agency Administrators and SE Leaders
Work skills continued
What medical benefits do
you get?
What medical benefits? _____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Do you manage your own
money?
Yes
No
Do you know how earnings
from work will affect other
sources of income and
medical benefits?
Yes
No
Have you spoken with a
benefits counselor? If not,
would you like to?
Yes
No Would you like to? Yes
No
Vocational Profile
The second tool is the Individual Employment
Plan; an example of it is on the next page.
Similar to the Vocational Profile, this form should
be completed in the first few weeks after
consumers are referred to the SE program.
Completing the form should not slow down the
job search. Instead, you may add information
to the Individual Employment Plan as it
becomes available.
Tips for Agency Administrators and SE Leaders 34 Building Your Program
Sample Individual Employment Plan
Individual
Employment
Plan
Consumer name ______________________ I.D. number
Completed by Date: __/___/___
Overall vocational goal:
Objective 1
Intervention
People responsible
Target date
__/___/___
Date objective achieved
__/___/___
Objective 2
Intervention
People responsible
Target date
__/___/___
Date objective achieved
__/___/___
Date job search began __/___/___
Employers contacted
Employer Date contacted
__/___/___
__/___/___
__/___/___
__/___/___
__/___/___
Building Your Program 35 Tips for Agency Administrators and SE Leaders
We strongly encourage you to adapt these forms
and incorporate them into your routine paperwork.
For printable copies, see the CD-ROM for this
KIT. For a more detailed discussion of the
assessment and treatment planning process,
see Training Frontline Staff in this KIT.
Describe how to maintain
consumer records
In your SE policies and procedures, describe
how you will maintain consumer records.
You must maintain records for each consumer
and safeguard them against loss, tampering,
and unauthorized use. The records should be
consistent with the Joint Commission (formerly
known as the Joint Commission on Accreditation
of Healthcare Organizations) and Centers for
Medicaid and Medicare Services requirements.
If you are creating a new recordkeeping system,
you will need materials to create records (for
example, binders and forms) and to store them
appropriately. You also need written policies and
procedures for documenting and maintaining
records. Educate your SE team and supervise
them in completing the required documentation.
Discuss how to ensure consumers’ rights
In your SE policies and procedures, discuss how
you will ensure that consumers’ rights are upheld.
Employment specialists should be aware of the
state and federal consumer rights requirements,
especially the Americans with Disabilities Act (ADA).
For more information, visit
DisabilityInfo.gov.
Furthermore, your SE policies and procedures
should reflect the model’s recovery orientation.
Traditional services were developed with a
biomedical approach to mental health treatment;
they focus on reducing symptoms and preventing
relapse. In contrast, the SE model is based on the
concept of recovery. In the recovery framework,
the expectation is that consumers can live a life
in which mental illness is not the driving factor
for their lives. Recovery means more than
“maintaining” people with mental illnesses in the
community. Recovery-oriented services encourage
consumers to define and fulfill their personal goals,
such as a goal to work.
Employment specialists must believe in and be
true to the recovery principles within the SE
model. SE teams should be careful not to replicate
those elements of traditional services that simply
emphasize containing symptoms and complying
with medication.
The value of consumer choice in service delivery
and the importance of consumer perceptions must
be infused in how you provide SE services. Most
practitioners have never examined their own
attitudes and behaviors about consumer recovery
and, therefore, uncritically accept many clinical
traditions without paying attention to how
disempowering these practices are for consumers.
In recovery-based SE services, establishing
a trusting relationship is critical. Interactions
with consumers should be based on mutuality
and respect.
n Employment specialists should be challenged to
listen to, believe in, and understand consumers’
perspectives and take into account consumers’
reasons for “noncompliance.”
n Employment specialists should also focus
on consumer-defined needs and preferences
and accept consumer choice in service delivery.
SE services provided with a recovery orientation
mean that employment specialists put more effort
into supporting and empowering consumers to
achieve their individual goals.
Tips for Agency Administrators and SE Leaders 36 Building Your Program
How administrators and SE leaders
can help provide recovery-oriented
SE services
n Clearly explain consumer rights in SE policies
and procedures
n Offer training on recovery principles and
consumer rights
n Hold community forums using the
multimedia tools in this KIT
n Involve consumers in local advisory groups
Develop procedures to evaluate program
and team member performance
When properly implemented, SE services are
associated with a variety of positive outcomes.
For example, consumers in SE programs were
more likely to achieve these goals:
n Obtain competitive work;
n Earn higher wages;
n Work more hours;
n Show improved symptoms;
n Show improved self-esteem; and
n Express satisfaction with their finances.
Evaluating the performance of your SE program
will help you provide high-quality services to
consumers and assure stakeholders of the effective
performance of your SE program. We recommend
that you develop procedures to evaluate your SE
program early using the guidelines in Evaluating
Your Program in this KIT.
Additionally, you should develop procedures for how
you will supervise and evaluate the performance of
your SE team. To a large extent, clinical supervision
is the process that will determine whether your SE
team will simply be a group of mental health
professionals doing what they’ve always done or
whether they will truly change and provide services
in an evidence-based way.
We recommend that SE leaders supervise the SE
staff weekly. Group supervision should review all
consumers involved in the SE program and
problem-solve ways to help them better meet
their individual goals.
Because SE leaders dedicate some time to direct
services, they will be familiar with all of the parts
of providing SE services. SE leaders will not just
review “cases” that employment specialists present,
but will also be able to actively problem-solve using
SE principles and techniques. SE leaders also
provide individual, side-by-side supervision,
as follows:
n To assess performance;
n To give feedback; and
n To model interventions.
SE leaders may schedule regular meetings with
employment specialists to review specific cases.
They should be regularly available to consult with
employment specialists, as needed.
Some aspects of the employment specialist’s job
are hard to understand without seeing them done
by an experienced practitioner. Once SE leaders
thoroughly understand the SE model, they should
take employment specialists out into the field
to model aspects of the job—such as job
development—and directly coach them in their
work. For training tools and recommendations,
see Training Frontline Staff in this KIT.
If the SE team is working with a consultant, the
SE leader should involve the consultant in group
supervision, treatment team meetings, and job
development meetings. In many new SE programs,
it has been found that feedback from an external
consultant is a crucial component for improving
staff performance and the quality of the program
as a whole.
Building Your Program 37 Tips for Agency Administrators and SE Leaders
Develop a training plan
Developing an SE team is a complex undertaking.
Recruiting and retaining employment specialists
who know the SE model or who know how to treat
consumers can be difficult. Agencies that have
successfully implemented an SE program indicate
that offering one-time training for employment
specialists is not enough. Instead, you should
assess the knowledge level of key stakeholders
(See Evaluating Your Program) and develop
a training plan.
Additionally, consumers, families, and other key
stakeholders may hold misconceptions about
consumers’ ability and desire to work or how work
may affect their benefits. It is important to correct
false beliefs before they impede implementing your
SE program. Consider organizing routine
educational meetings for consumers, families, or
other key stakeholders in which consumers who
have received SE services or employers who have
hired consumers through an SE program share
their experiences. For materials to support this
basic training, see Using Multimedia to Introduce
Your EBP. You will find these resources:
n An introductory PowerPoint presentation;
n A sample brochure in both English and Spanish;
and
n The introductory video.
Once trained, SE leaders and employment
specialists will be able to use these materials to
conduct routine community workshops and in-
service seminars. Furthermore, the SE KIT
includes Training Frontline Staff, which gives
employment specialists in-depth information about
the SE model and skills for providing SE services.
SE leaders may facilitate a structured group
training using these materials.
Once employment specialists have a basic
understanding of the model, we recommend that
they visit an existing, well-functioning, high-fidelity
SE team to observe how employment specialists
work with consumers and how they interact with
one another.
In addition to in-depth training on the SE model, we
also suggest that you offer basic training on benefits
and work incentives to employment specialists and
other practitioners. Employment specialists should
be able to define the following terms:
n Medicaid and 1619B Medicaid;
n Medicaid for the Working Disabled;
n Medicare;
What should your training
plan include?
n Basic training for key stakeholders, including
consumers, families, mental health authorities,
and members of key community organizations
n Basic training for staff at all levels across
the agency
n Intensive training for employment specialists
n Basic training on benefits and work incentives
Practitioners who implement evidence-based
practices (EBPs) are often stymied in their efforts
because people misunderstand the model or lack
information. It is important that key stakeholders
(consumers, families, and other essential
community members) and agency-wide staff
develop a basic understanding of SE.
This training will build support for your SE
program. Your SE staff will find that they are better
able to generate referrals for their SE program,
develop job leads, and provide job supports. Since
effective SE services depend on integrating SE and
clinical services, it is important for all members of
the treatment team to have a basic understanding
of the SE model.
Voices of Experience 38 Building Your Program
n Supplemental Security Income (SSI);
n Social Security Disability Insurance (SSDI);
n Plan for Achieving Self-Support (PASS);
n Impairment-Related Work Expense;
n Substantial Gainful Employment (SGA);
n Ticket to Work;
n Expedited reinstatement for benefits; and
n The Department of Housing and Urban
Development (HUD) mandatory earned income
inclusion.
Rules about benefits are complicated and are
periodically adjusted, which makes it hard to stay up
to date. Resources are available to help you develop
and maintain your staff’s knowledge about benefits.
Consider regularly offering training on benefits
to help SE staff stay as current as possible. Contact
the Social Security Administration to find training
resources. The Social Security Administration
has Area Work Incentive Coordinators (AWICS)
in every state, and many local Social Security
Administration offices also have Work Incentive
Liaisons who can provide training and consultation
to agencies and staff. Visit
DisabilityInfo.gov for
more information.
Another resource is the Social Security
Administration’s Redbook. Use it as a reference
guide for SSDI and SSI. To see the Redbook online,
go to
www.ssa.gov/work.
Hire an external consultant and trainer
Establishing the initial processes that must be
in place to provide quality services requires great
attention to detail. Consequently, during the first
1 to 2 years after forming a new SE team, many
agencies have found it helpful to work with an
experienced external consultant and trainer.
Consultants and SE leaders often work together
over the 2 years to ensure that the SE program
is structured appropriately. They integrate SE
principles into the agency’s policies and tailor
SE program procedures to meet local needs.
Once the program has been launched, it is
important that you do not allow employment
specialists to revert to older and more familiar ways
of doing things. External consultants and trainers
who are experienced in running SE programs can
provide ongoing technical assistance, side-by-side
supervision, and periodic booster training sessions.
This type of assistance, along with ongoing
evaluation of fidelity and outcomes, has been
found to be critical in maintaining adherence
to SE practices.
Select a location for your
SE program
Although employment specialists will spend 60
percent or more time in the community, sometimes
they will meet with consumers in your agency.
For this reason, it is important for employment
specialists to have a place to meet with consumers
and to have access to a desk, a phone, voice mail,
and a computer that includes Internet capabilities.
Building Your Program 39 Voices of Experience
Office space should not be separate from the rest
of the clinical treatment team. Ideally, the offices
are intermingled and the space is consistent with
how space is allotted for other team members.
Touching base in the hall and lunchroom with
other treatment team members providing SE
services facilitates ongoing communication that
supports the goals of SE.
Additionally, access to a cell phone for outreach
work can increase safety and improve
communication. Marketing materials such as
business cards and a SE brochure also facilitate
job development activities. See Using Multimedia
to Introduce Your EBP in this KIT for a sample
SE brochure.
Review your SE program budget
and revenue sources
It is important for you to understand your SE
program budget and revenue sources so that you
can actively participate in the budgeting process,
make informed management decisions, and
understand where collateral revenue sources are
most needed.
In some mental health systems, SE programs
receive a fixed rate for each consumer who receives
services. In other systems, SE programs are only
reimbursed based on the specific services provided.
In that case, you should be familiar with how
services must be tracked to capture billing from
various funding streams. You will also need to know
the billing process and billing codes.
Financing mechanisms for SE vary from agency
to agency. The leaders of numerous agencies
and systems have successfully established ways
to fund SE services using Medicaid, vocational
rehabilitation funding, and other sources.
In some states, mental health authorities have
worked out a mechanism to pool funds that can
be used to reimburse the services of SE programs.
Also, state Medicaid rules may allow
reimbursement for selected SE activities.
Financial barriers can slow implementation.
Consulting with agencies and system administrators
who have been successful in this area can give you
useful ideas and strategies.
Consider how implementing SE will affect
the agency.
n Will some types of services be reduced or
eliminated in order to pay for your SE program?
n What will the impact of decreased group
attendance be when consumers go to work?
n Will evening hours be needed?
Be aware that over time the mission and activities
of programs can become defined by the funding
that supports them. Know the principles of SE
and be vigilant that funding opportunities support
the model rather than shape and corrode it.
In summary, building an effective, well-functioning
SE team is a developmental process. We encourage
you to periodically revisit the information in this
KIT throughout the first year after starting your
new program. We believe that these materials
will take on a new meaning as the process of
implementing an SE program evolves.
DHHS Publication No. SMA-08-4364
Printed 2009
24771.0409.7765020404
