Perceptions and practices of mental health professionals regarding the employment of people with serious mental illness

Abstract

BACKGROUND:

The Individual Placement and Support (IPS) model of Supported Employment (SE) is an evidence-based practice that leads to an increase in successful employment outcomes for people with serious mental illness (Bond, Drake, & Becker, 2008). The practical application and implementation of this practice, however, is limited in the Southeastern region of the United States.

OBJECTIVE:

This study examined the perceptions held by and practices used by mental health professionals regarding the employment of individuals with serious mental illness at two sites in Alabama.

METHODS:

The two sites yielded 79 participants, including clinicians and case managers, who responded to the Health Professional Perceptions of Employment Survey - Revised. Analysis of the quantitative data was completed using an independent samples t-test, Pearson product moment correlation coefficient, and Spearman rank correlation coefficient. The qualitative data was analyzed for common themes based on survey responses.

RESULTS:

A statistically significant relationship was identified that supports the connection between perceptions and practices of mental health professionals related to the employment of people with serious mental illness.

CONCLUSIONS:

Mental health professionals’ attitudes toward employment affects their consideration of employment for their clients, which will help or hinder the clients’ vocational progress and recovery.

Keywords

Individual placement and support supported employment individuals with serious mental illness vocational rehabilitation

1 Introduction

Stigma theory posits that people with disabilities face barriers due to social inequalities, negative attitudes, and devalued roles, not because of their diagnoses (Thomson, 1997). If people with disabilities are to be better accepted and included in society, then rehabilitation and mental health professionals must consider actions and strategies that enable all people to have positive and valued roles. The potential for supported employment to be the methodology to move people, once excluded, to the valued role of employee cannot be overstated (Tyree, Kendrick, & Block, 2011). Supported employment is competitive employment in an integrated setting with ongoing support services for individuals with the most significant disabilities (CFR, 2017). It is designed uniquely for people for whom competitive employment has not occurred historically or for whom competitive employment has been interrupted or intermittent because of a most significant disability (CFR, 2017). Due to the nature and severity of some disabilities, individuals may need intensive and extended support services to work successfully (CFR, 2017).

Supported employment is a cost-effective service that leads to competitive employment outcomes for people with the most significant disabilities within the current Vocational Rehabilitation system (Cimera, 2010). Despite evidence that supported employment is an effective service for individuals with serious mental illness pursuing employment, only 1.7 percent of individuals served by mental health agencies receive supported employment services (Substance Abuse and Mental Health Services Administration [SAMHSA], 2012). Work helps people previously excluded from society to have the opportunity for a typical life, and that such a life can be obtained in the context of people being in valued social roles, such as employee, within their communities (Lemay, 2006; Tyree, Kendrick, & Block, 2011).

Although there are several SE models, the Individual Placement and Support (IPS) model developed by Becker and Drake is the most researched and is recognized as evidence-based supported employment (Bond, Drake, & Becker, 2008). The core principles of IPS are 1) competitive employment is the focus, 2) eligibility is based on consumer choice, 3) rapid job search is utilized, 4) mental health and employment services are integrated, 5) attention is given to consumer preference in the job search process, 6) individualized job supports are utilized, 7) relationships are developed with employers to understand the business needs, and 8) personalized benefits counseling is provided to consumers (Bond, 2004; Bond, Drake & Becker, 2008).

Understanding the clinical team’s perspective on the role of employment in recovery and their perceptions of the employment prospects of clients is important. Mental health professionals’ attitudes toward employment can (a) determine the rate of referrals and (b) help or hinder the clients’ vocational progress (Gladman et al., 2015). Evidence-based practices such as IPS are well established through research as having a significant impact on successful employment outcomes for people with serious mental illness (Bond, 2004; Bond, Drake, & Becker, 2008). Yet the IPS model is not readily available to most individuals with SMI; while it is a service available in most states, it is not typically offered statewide (Drake, Bond, Goldman, Hogan, & Karakus, 2016; Kwochka-Johnson, Bond, Becker, Drake, & Greene, 2017; SAMHSA, 2012).

The purpose of this study was to assess the perceptions and practices of mental health professionals related to the employment of individuals with serious mental illness. This study focused on mental health professionals working at two different Alabama mental health facilities preparing to implement the IPS model of supported employment. To address the goals of this article, the following four research questions guided the study:

Research Question 1: To what extent do mental health professionals value competitive integrated employment for people with serious mental illness who are in recovery?

Research Question 2: To what extent is there an association among mental health team members’ acceptance, support, and value of an employment specialist?

Research Question 3: To what extent is there a relationship between perceptions and practices of mental health professionals related to the employment of people with serious mental illness?

Research Question 4: What challenges exist in implementing the evidence-based practice of Individual Placement and Support?

2 Method

2.1 Participants

The sample for this study was drawn from two mental health centers in Alabama. There are thirty mental health centers in the State of Alabama (ADMH, 2013). Some of these centers offer eligible adults with serious mental illness the following services: adult case management, adult crisis stabilization, adult in-home interventions, adult intensive day treatment, adult outpatient, assertive community treatment, and services for children and adolescents. Additionally, centers may offer: consultation and education, emergency services, forensic case management, geriatric care, partial hospitalization, indigent drug program, rehabilitative day program, and residential services (ADMH, 2013). Prior to the implementation of the IPS model of supported employment, there were no formalized mental health employment services. There was some vocational readiness training available at day programs or people were referred to vocational rehabilitation (ADMH, 2013).

The two sites were included in the study as both were previously selected as pilot sites for implementing IPS in Alabama; one is in the north central part of the state and rural (Site A), and the second is in the southern part of the state and urban (Site B). IPS services had not begun at the time the survey was administered. Personnel at the two sites who work with adults who have a mental health diagnosis were given an opportunity to respond to the questionnaire. The approximate number of personnel who were given an opportunity to respond to the questionnaire from Site A was 40; the approximate number from Site B was 60. Participants at each of the sites were clinicians, case managers, and newly hired employment specialists. Individual demographic information was not solicited as the focus was on the overall perceptions and practices at the mental health centers prior to implementing IPS.

2.2 Instrument

The Health Professionals Perceptions of Employment Survey (HPPE, Version 2) instrument developed by Gladman, Waghorn, Wishar, and Dias (2015) was adapted for use in this study. Gladman et al. (2015) evaluated the HPPE for face validity to ensure that language used in each question/item had meaning for health professionals and test-retest reliability for internal consistency and to ensure agreement over multiple administrations. The researchers concluded that the “HPPE is an acceptable, reliable, and promising tool for monitoring the integration of mental health services with an evidence-based supported employment program” (Gladman et al., 2015, p. 7). The final version of the HPPE (Version 2) included nineteen items.

The survey used for this study was “Health Professionals Perceptions of Employment – Revised” (HPPE-REV) (Fleming, 2015), which was adapted from the HPPE (Version 2). Permission was granted by Gladman for the modifications of the original instrument and its use in this study. The HPPE-REV resulted in a 24-item instrument. Several items were reworded in such a way that meaningful responses could be collected on a five-point Likert-type scale. For example, the HPPE (Version 2) had one question that asked about valuing, supporting, and accepting the employment specialist, while the HPPE-REV modified that question into three separate questions. The modifications and additions made to the HPPE-REV were the result of input from a panel of experts, which included three mental health and/or rehabilitation professionals and a researcher. The panel of experts served to validate the face, content, and construct validity of the HPPE-REV.

2.3 Procedure

Steps were taken to ensure the privacy and confidentiality of the data collected. The researcher obtained permission from the Institutional Review Board (IRB) at Auburn University to conduct the study. Data were recorded in an electronic database via SPSS. Data obtained in connection with this study were reported in the aggregate and remained anonymous.

The HPPE-REV survey instrument was distributed by the researcher at the two mental health centers. Mental health professionals completed the survey instrument in approximately 20 minutes and were returned anonymously. Staff members that were not able to attend the survey day were given the opportunity to complete the questionnaire and mail it to the researcher. The researcher went to the two sites to distribute the survey instrument to increase the likelihood of obtaining a high response rate, which provided greater confidence in the generalizability of the results (Patten, 2014).

2.4 Data analysis

The data collected were entered into a spreadsheet for statistical analysis in the Statistical Package for the Social Sciences (SPSS). The comments and open-ended questions were recorded in a table in a Word document organized by question and participant role. Descriptive data such as frequencies and percentages were summarized for position title, number of participants, caseload size, and years of service in mental health. Background information of the participants were examined regarding mentoring and supervisory duties, perceptions of percentage of caseload capable of working part-time or full-time, percentage of caseload in which employment is discussed, and summarizing themes from open responses regarding challenges and successes experienced when referring to the employment specialist, and suggestions to support clients in their vocational pursuits.

Analysis of the quantitative data was completed for each research question. Research question one was examined by using an independent samples t-test to determine the extent to which mental health professionals value competitive integrated employment for people with serious mental illness. Research question two was investigated by means of the Pearson product moment correlation coefficient procedure to ascertain association among the variables of acceptance, support, and value of the employment specialist for the mental health treatment team. Research question three was explored by using the Spearman rank correlation coefficient procedure to determine if there was a relationship between perceptions held and practices used by mental health professionals. Qualitative data collected for research question four was addressed with an analysis of common themes found in responses related to knowledge of IPS, determination of job readiness, availability of employment specialist, and strategies used to integrate employment into current treatment.

3 Results

3.1 Descriptive statistics

The total number of participants was 79 with 29 (36.7%) participants from Site A, and 50 (63.3%) from Site B. Participants were asked to provide years of service and position type to see if there was a relationship between years of service and position type to the perceptions and practices about employment. All participants reported a mean number of years of service in mental health as 9.61 with a standard deviation of 8.32. The median number of years working in the mental health profession was 8. The minimum number of years of service was less than one and the maximum number of years was 35. The positions of the participants included 26 case managers, 4 employment specialists, 18 counselors/therapists, 12 nurses (LPN, RN), 8 coordinators, and 10 administrative positions (program director, assistant directors, project managers, and outreach liaison). Employment Specialists were included since the IPS service had not begun and no consumer had been contacted. Seven participants reported that they had no active clients on their current caseloads, and one participant reported 400 active clients on the current caseload, which was the maximum number of active clients reported for one caseload. The average number of active clients was 56, with a standard deviation of 68. The median number of active clients on a caseload was 31.

3.2 Participants’ working roles and current observations of employment

Twenty-seven of all participants reported that they had responsibilities for supervising or mentoring other staff members. Participants were asked to consider their current active caseload (indicating contact in the past six weeks) and to estimate the proportion that is capable of working. The mean score (N = 70) for the percentage perceived as capable of working full-time was 23% and the percentage perceived as capable of working part-time was 45%. Participants with caseloads were asked to indicate the percent of their active cases with whom they have discussed vocational goals; 54% of the participants (N = 38) indicated they discussed vocational goals (including education, training, or employment goals) with 50% or less of their caseload, and 46% of the participants (N = 32) indicated they discussed vocational goals (including education, training, or employment goals) with 75% – 100% of their caseload.

Additionally, respondents were asked to share challenges and successes when referring people to employment specialists. The top four challenges were identified as: the client, the employment specialist, the lack of transportation, and the lack of available jobs. Of the above challenges, thirty-eight of the 79 participants (48%) responded that the client was a factor when considering employment given (a) fears of losing disability benefits, (b) uncertainty about work, (c) not being able to follow the treatment plan, and (d) not following up with the employment specialist after being referred. Furthermore, seventeen of the 79 participants (22%) noted that the employment specialist and/or vocational rehabilitation were a challenge given (a) difficulties in referring, (b) delay in receiving services, (c) communication difficulties, and (d) the lack of availability of the employment specialist or the VR counselor. Participants identified successes and strategies for supporting clients with vocational pursuits. The participants’ working roles and current observations of employment are highlighted in Table 1.

Table 1
Current Observations of Employment

Percentage of caseload capable of working part-time or full-time

Mental health professionals (N = 70) reported that 45% of their caseload is capable of part-time work and 23% is capable of full-time work.

Percentage of caseload employment is discussed

38 participants reported that they discuss employment with 50% or less of their caseload

32 participants reported that they discuss employment with 75–100% of their caseload

Challenges and successes of referring clients to employment specialists

Challenges Success

48% reported the client’s 41% reported when refer to the employment specialists people go to work

•Fear of losing benefits

•Lack of childcare

•Non-compliance with treatment

22% reported the employment specialist

11% reported lack of transportation

10% reported lack of available jobs

3.3 Research question 1

The extent to which mental health professionals’ value competitive integrated employment for people with serious mental illness who are in recovery yielded the following: All of the 79 participants responded to this survey item. Thirty-eight of the participants strongly valued competitive integrated employment for people with serious mental illness who are in recovery, 21 strongly valued competitive integrated employment, and 17 very strongly valued competitive integrated employment for people with serious mental illness who are in recovery.

An independent samples t-test was performed to test the first research question for difference in value of competitive integrated employment between participants who had worked the median number of years (eight) and those who had worked more than the median number of years. Results of the test, t₍₇₇₎ = 0.605, p = 0.547, with the 95% confidence interval of the difference (–0.141) ranging from –0.604 to 0.322 indicated a very narrow array of scores. Therefore, the null hypothesis was retained. The mean score for participants with eight or fewer years of service (N = 43) was 3.58, with a standard deviation of 1.05 and the mean score for participants with more than eight years of service (N = 36) was 3.72, with a standard deviation of 1.00.

3.4 Research question 2

The second research question examined the extent there was an association among mental health team members’ acceptance, support, and value of an employment specialist and was tested using the Pearson product moment correlation coefficient procedure to ascertain associations among the variables. Pearson correlation coefficients were statistically significant at the 0.01 alpha level for all pairs of correlations, with the strongest correlation (0.769) between acceptance of an employment specialist and value of an employment specialist. The correlations between the remaining pairs were also very strong: acceptance of an employment specialist and support of an employment specialist (0.674), and support of an employment specialist and value of an employment specialist (0.673). Therefore, the null hypothesis for associations of acceptance of an employment specialist, support of an employment specialist, and value of an employment specialist among mental health team members was rejected.

3.5 Research question 3

The third research question studied the extent there was a relationship between perceptions and practices of mental health professionals related to the employment of people with serious mental illness. Research question three was tested using the Spearman rank correlation coefficient [Spearman rho (ρ)] procedure to ascertain a relationship between perceptions and practices of mental health professionals related to the employment of people with serious mental illness. Results of the analysis show a moderate correlation and a statistically significant relationship (ρ = 0.292, p = 0.031) between responses for perceptions (N = 55) and practices (N = 69) of mental health professionals related to the employment of people with serious mental illness. Therefore, the null hypothesis for no relationship between perceptions and practices was rejected.

3.6 Research question 4

The fourth research question identified challenges by participants regarding implementing the evidence-based practice of Individual Placement and Support (IPS); common themes are summarized from participant responses regarding knowledge of IPS and where it was learned, determining job readiness, availability of an employment specialist, and strategies used to integrate employment into current treatment. Sixty (60) of the 79 participants responded that they did not know the IPS model of supported employment. Of the clinicians and case managers who responded that they did know IPS, their responses ranged from a program that assists people with serious mental illness to find and keep a job to a document used to develop an individual plan of care. The 18 respondents who said they knew IPS stated that they learned from co-workers, a Dartmouth University presentation, or from the Substance Abuse Mental Health Services Administration (SAMHSA) grant recently awarded to the mental health agency to implement IPS.

The participants were asked to indicate the availability of an employment specialist, someone available to assist people with serious mental illness with their employment goals. Forty-two (42) of the 79 participants (greater than 50%) reported that they had access to an employment specialist who was linked to their mental health team and was capable of assisting their clients with work goals. Eleven participants indicated that an employment specialist was not able to deliver suitable employment services. Thirteen respondents stated that the employment specialist was available in the community. Seven participants felt the provider arranged to assist clients with their vocational goals was not able to meet the needs of the clients, with three respondents indicating there was no one available to assist their clients with work goals. Three people chose not to respond to this question.

The participants were asked to describe how they determine if someone is ready to be referred to supported employment services; the responses fell into four vital areas: 1) compliance with treatment and/or medication, 2) stated desire to work, 3) medical stability, and 4) treatment team agrees work is viable. The participants were also asked to describe current strategies used to integrate employment into the existing program; the responses formed four overarching themes: 1) Ask the client if he or she wants to work, encourage the client to consider work, or discuss work with the client; 2) Avoid the topic of employment as most people with SMI cannot work; 3) Talk about work as often as possible and brainstorm possibilities; and 4) Refer to VR if work is mentioned. Participants shared their strategies for supporting clients’ vocational pursuits:

Work with client to address anticipated barriers, such as transportation,

Get to know clients to identify skills, abilities, interests, motivation, capabilities, and goals,

Refer to benefits specialist,

Communication between mental health practitioners, employment specialists, vocational counselors, consumer, and employer is important,

Client compliance with treatment plan and managing symptoms,

Know resources: education and training opportunities available,

Setting goals around work,

Integrate employment team and mental health treatment team,

Job seeking skills – resume development, interview skills, application, etc.,

Refer to vocational rehabilitation and employment specialists, and

Promote system management.

4 Discussion

Employment gives people a sense of purpose, helps to build self-esteem and self-worth that research has shown decreases symptoms of an individual’s mental illness, and reduces the need for other services, such as hospitalization and crisis interventions (Becker, Whitley, Bailey, & Drake, 2007). The IPS model seeks to help individuals with serious mental illness find jobs that meet their unique needs, interests, and skills, and to support them in ways that enable them to succeed in the workplace (Karakus et al., 2011). A review of the empirical random-controlled trials of IPS programs concluded that vocational outcomes are consistently significantly higher than alternative control programs (Becker, et al., 2007; Becker, Lynde & Swanson, 2008; Becker, Whitley, Bailey, & Drake, 2007; Bond, 2004; Bond et al., 2007; Bond, Drake, & Becker, 2008; Bond, et al., 2008; Drake, Becker, Bond, & Mueser, 2003; Drake, Becker, Clark & Mueser, 1999; Drake, et al., 2016; Dreher, Bond, & Becker, 2010; Karakus et al., 2011; Marshall et al., 2014; Mueser et al., 2004).

The use of strategies and services that facilitate obtaining integrated, non-stereotypical, individualized, and paid employment for people with the most significant disabilities is critical for the success of vocational rehabilitation and the individuals it serves (CFR, 2012). However, no single system can pay for and provide the array of services needed to meet effectively the often-complex needs of individuals with serious mental illness (Luecking et al., 2008). When agencies work together, their combined resources can create positive results. Service gaps, duplication of services, cost ineffectiveness, and inaccessibility of services can be resolved through coordination between human service agencies and funders (Metzel, Foley, & Butterworth, 2005). Collaborative efforts that pull together a multitude of resources, funding, and expertise contribute to successful employment outcomes for individuals with the most significant disabilities (Fesko, Varney, Dibiase, & Hippenstiel, 2007). Such partnerships have emerged when they have utilized the IPS model of supported employment.

The significance of this study has practical applications. Understanding how practitioners perceive and practice strategies regarding employment of individuals with serious mental illness, could lead to improving implementation and availability of IPS practices throughout the nation. In addition, this information could provide insights to researchers about potential professional development needs and goals, current uses of evidence-based practices, and knowledge of IPS.

4.1 Limitations

Conclusions drawn from the results of this study are limited by the following considerations. The scope of this study was limited to mental health professionals employed at two different mental health sites in Alabama. Additionally, this study was based on several assumptions, that: participants responded honestly to the questionnaire, participants were confident in their ability to perceive the employment potential for the consumers they serve, participants were confident in their knowledge of practices that assist people with serious mental illness reach their employment potential, and that the questionnaire items were designed to reflect true perceptions held and daily practices used by mental health professionals.

4.2 Implications

The results of this study indicate there is no difference in length of service in determining if mental health professionals value competitive integrated employment, with over 48% of the participants’ strongly valuing or very strongly valuing competitive integrated employment. These findings concur with the literature (Becker, Whitley, Bailey, & Drake, 2007; Lemay, 2006; Tyree, Kendrick, & Block, 2011) that work helps people have the potential for a more typical life, gives people a sense of purpose, and facilitates building self-esteem and self-worth.

The mental health professionals who completed the survey are not confident in the employment potential of the consumers they counsel. The mental health professionals who completed the survey believe their clients capable of working only part-time (45%) and full-time (23%), which means some are considered incapable of working. Congruently, the results indicated that the majority of participants with caseloads discuss vocational goals with 50% or fewer of their clients.

There is an association among the variables of acceptance, support, and value of an employment specialist among mental health team members. The association among acceptance, value, and support of the employment specialist is statistically significant with greater than 50% of the participants reporting access to a qualified employment specialist. However, there is a concern that clinicians and case managers may not refer to the employment specialists since they expected their clients to be compliant with treatment and/or medication and to be medically stable before considering someone for employment.

There is a relationship between perceptions and practices of mental health professionals related to the employment of people with serious mental illness. The relationship between perceptions and practices of mental health professionals related to the employment of people with serious mental illness is statistically significant. Previous research by Gladman et al. (2015) also reported that understanding the clinical team’s perspective about the role of employment in recovery and how team members perceive the employment prospects of their current clients are important. Mental health professionals’ attitudes toward client employment can determine such practice as their rate of referrals, which could help or hinder the clients’ vocational progress. Current practices and perceptions reported by mental health professionals are not supportive of employment for consumers with SMI. It is hoped that with a better understanding of the IPS principles the expectations and practices related to employment for individuals with serious mental illness will change.

4.3 Implications for research

The research for this study concentrated on mental health professionals who work at two different Alabama mental health facilities that were preparing to implement the IPS model of supported employment. It might be useful to repeat the survey after the sites receive training regarding IPS and begins to implement an employment focused program. The study indicates that extensive training and ongoing technical assistance is needed for implementation to be successful. In addition, future research could expand the scope to include all mental health centers in Alabama. This could help determine who has an employment focus, the level of professional development needed, and readiness for systems change. The survey responses could provide information regarding mental health professionals’ perceptions about IPS and practices that could lead to fine-tuning implementation.

4.4 Implications for practice

The results of this study further suggest several implications: while mental health professionals value competitive integrated employment in the recovery of their clients, they do not believe their clients are ready to go to work. Changing this perception through education about and implementation of the IPS model, as well as seeing their clients go to work could change current practices so that more clients are referred to the employment specialist, thereby increasing the number of people with SMI who go to work. The reality of seeing people go to work they thought could not work can change perceptions, which is also an IPS strategy of sharing success stories. The IPS evidence-based model of SE is by far the most effective way to help people with serious mental illness work in competitive integrated positions (Becker, Lynde, & Swanson, 2008). The mental health and vocational rehabilitation agencies should have someone available who is competent to provide training regarding the principles of IPS and to offer technical assistance during the implementation of IPS that will facilitate the understanding and application of those principles by mental health and rehabilitation professionals.

Overall, mental health professionals recommended a few strategies for success with employment that are in alignment with IPS strategies and principles. While the participants indicated competitive integrated employment (a principle of IPS) was part of the recovery process, they also shared numerous concerns about clients being able to pursue vocational goals. One of the principles of IPS is that all individuals who state they want to work are given an immediate opportunity to seek employment; however, several participants reported that they would not refer until they felt the consumer was ready.

It is pertinent to note that the principles of IPS could address most of the concerns raised. Strategies reported by the mental health professionals were often analogous to IPS principles. Participants reported that clients were hesitant to seek employment for a variety of reasons: the uncertainty of getting a job, anxiety about the workplace, concerns over juggling medication while at work, and the fear of losing benefits. Yet a principle of IPS is the delivery of benefits counseling so the consumer can explore the impact of going to work while receiving disability benefits. This process allows the individual to develop a viable work plan while making informed choices, and thereby reducing fears. While participants shared concerns about clients’ successes, an IPS principle addresses the integration of vocational services with mental health treatment, which increases the availability of needed supports to go to work. Numerous participants also recommended the need for increased communication and collaboration among the mental health counselor, the employment specialist, and the vocational rehabilitation counselor to improve employment outcomes. In addition, practitioners reported that the client should be consulted throughout the process; the IPS corollary also requires that the client’s preferences be honored.

Current practices noted by the participants are to refer clients to VR or the employment specialist when work is mentioned. IPS principles expand the role of the mental health professionals to ensure job search is initiated quickly, to make certain the employment specialist builds relationships with the business community, and to confirm workplace supports are arranged and delivered as long as the individual needs such supports. Given the numerous areas of overlap and the possibility that IPS can address the concerns raised, one could anticipate a positive response toward change and implementation of the IPS model, which also builds on existing successes to increase utilization of the employment specialists and the employment of people with serious mental illness.

5 Conclusion

It is confounding that despite the evidence that supported employment is effective in assisting people with serious mental illness to seek, secure, and sustain employment, SE continues to be unavailable for most people (SAMHSA, 2012). The results of the research on IPS clearly indicate that this model positively influences the employment outcomes of people with serious mental illness. Therefore, to increase positive employment outcomes for individuals with serious mental illness, the perceptions and practices of mental health professionals must align with the principles of IPS. Kelsey and Smart (2012) noted that social justice is the fundamental valuing of fairness and equity of resources, rights, and treatment. Pursuing social justice, community inclusion, universal access, and full participation in the community allows all people, particularly those with the most significant disabilities, to secure valued social roles. To effect the necessary systems change, it no longer makes sense for researchers to identify what they think is important, conduct their research, and share the findings with each other (Klingner, Boardman, & McMaster, 2013). We as researchers must take the next step to facilitate the successful implementation of evidence based practices with practitioners and state agency personnel.

Conflict of interest

The authors declare that they have no conflicts of interest with respect to the research, authorship, and or publication of this article.

Ethics

Procedures involving experiments on human subjects were done in accord with the ethical standards of the Committee on Human Experimentation of the institution in which the experiments were done or in accord with the Helsinki Declaration of 1975.

Funding

The author(s) received no financial support for the research, authorship, and or publication of this article. However, the Alabama Department of Mental Health (ADMH) is in receipt of funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) grant number: 1H79SM061718-01 and the authors have a memorandum of agreement with ADMH for project evaluation. The ideas, opinions and conclusions expressed, however, are those of the authors and do not represent recommendation, endorsements, or polices of ADMH or SAMHSA

References

Alabama Department of Mental Health. (2013). Mental illness provider directory. Montgomery, AL.

Becker,

D. R.

, Baker,

S. R.

, Carlson,

, Flint,

, Howell,

, Lindsay,

, Moore,

, Reeder,

, & Drake,

R. E.

(2007). Critical strategies for implementing supported employment. Journal of Vocational Rehabilitation, 27(1), 13–20.

Becker,

D. R.

, Lynde,

, & Swanson,

S. J.

(2008). Strategies for state-wide implementation of supported employment: The Johnson & Johnson– Dartmouth Community Mental Health Program. Psychiatric Rehabilitation Journal, 31(4), 296–299. 10.2975/31.4.2008.296.299.

Becker,

, Whitley,

, Bailey,

, & Drake,

(2007). Long-term employment trajectories among participants with severe mental illness in supported employment. Psychiatric Services, 58(7), 922–927.

Bond,

(2004). Supported employment: Evidence for an evidence-based practice. Psychiatric Rehabilitation Services, 58, 922–928.

Bond,

, Drake,

, & Becker,

(2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal, 31, 280–290.

Bond,

G. R.

, Dincin,

, Fraser,

V. V.

, Salyers,

M. P.

, Drake,

R. E.

, Becker,

D. R.

, & Haines,

(2007). A randomized controlled trail comparing two vocational models for persons with severe mental illness. Journal of Consulting and Clinical Psychology, 75(6), 968–982. 10.1037/0022-006X.75.6.968.

Bond,

G. R.

, McHugo,

G. J.

, Becker,

D. R.

, Rapp,

C. A.

, & Whitley,

(2008). Fidelity of supported employment: Lessons learned from the national evidence-based practice project. Psychiatric Rehabilitation Journal, 31(4), 300–305. 10.2975/31.4.2008.300.305.

Cimera,

R. E.

(2010). The national cost-efficiency of supported employees with intellectual disabilities: The worker’s perspective. Journal of Vocational Rehabilitation, 33, 123–131.

10.

Chan,

, Rosenthal,

, & Pruett,

(2008). Evidence-based practice in the provision of rehabilitation services. Journal of Rehabilitation, 74(2), 3–5.

11.

Code of Federal Regulations. (November, 1, 2012). 7(11) and 12(C) of the Act; 29 U.S.C. 705(11), 706(18), 711(c), 795(j) and 709(C)). 34 CFR 361. Washington, DC: Author. Available at http://cfr.regstoday.com/34cfr363.aspx.

12.

Drake,

R. E.

, Becker,

D. R.

, Bond,

G. R.

, & Mueser,

K. T.

(2003). A process analysis of integrated and non-integrated approaches to supported employment. Journal of Vocational Rehabilitation, 18(1), 51–58.

13.

Drake,

R. E.

, Becker,

D. R.

, Clark,

R. E.

, & Mueser,

K. T.

(1999). Research on the Individual placement and support model of supported employment. Psychiatric Quarterly, 70(4), 289–301.

14.

Drake,

R. E.

, Bond,

G. R.

, Goldman,

H. H.

, Hogan,

M. F.

, & Karakus,

(2016). Individual placement and support services boost employment for people with serious mental illnesses, but funding is lacking. Health Affairs, 35(6), 1098–1105.

15.

Dreher,

, Bond,

, & Becker,

(2010). Creation of a measure to assess knowledge of the individual placement and support model. Psychiatric Rehabilitation Journal, 33, 181–189.

16.

Fesko,

, Varney,

, Dibiase,

, & Hippenstiel,

(2008). Effective partnerships: Collaborative efforts that support customized employment. Vocational Rehabilitation, 28, 159–168.

17.

Fleming,

(2015). Perceptions and Practices of Mental Health Professional Regarding the Employment of People with Serious Mental Illness. Unpublished dissertation, Auburn University.

18.

Gladman,

, Waghorn,

, Wishart,

, & Dias,

(2015). Reliability of health professionals’ perceptions of employment for people with severe mental illness. Journal of Rehabilitation, 81(1), 3–8.

19.

Harn,

, Parisi,

, & Stoolmiller,

(2013). Balancing fidelity with flexibility and fit: What do we really know about fidelity of implementation in schools?Exceptional Children, 79(2), 181–193.

20.

Karakus,

, Frey,

, Goldman,

, Fields,

, & Drake,

(2011) US Department of Health and Human Services, Federal financing of supported employment and customized employment for people with mental illnesses: Final Report. Washington, DC: Westat, Inc. Available at http://aspe.hhs.gov/daltcp/Reports/2011/supempfr.htm.

21.

Kwochka-Johnson,

, Bond,

G. R.

, Becker,

D. R.

, Drake,

R. E.

, & Greene,

M. A.

(2017). Prevalence and quality of individual placement and support (IPS) supported employment in the United States. Administration and Policy in Mental Health and Mental Health Services Research, 44(3), 311–319.

22.

Lemay,

(1999). Roles, identities, and expectations: Positive contributions of role theory to normalization and social role valorization. In

R. J.

Flynn &

R. A.

Lemay (Eds.), A quarter-century of normalization and social role valorization: Evolution and impact. Ottawa, ON: University of Ottawa Press.

23.

Luecking,

R. G.

, Cuozzo,

, Leedy,

M. J.

, & Seleznow,

(2008). Universal one-stop access: Pipedream or possibility?Journal of Vocational Rehabilitation, 28, 181–189.

24.

Marshall

, Goldberg,

, Braude,

, Dougherty,

, Daniels,

, Ghose,

, George,

, & Delphin-Rittmon

(2014). Supported employment: Assessing the evidence. Psychiatric Services, 65(1), 16–23.

25.

Metzel,

D. S.

, Foley,

S. M.

, & Butterworth,

(2005). State-level interagency agreements for supported employment of people with disabilities. Journal of Disability Policy Studies, 16(2), 102–114.

26.

Mueser,

K. T.

, Clark,

R. E.

, Haines,

, Drake,

R. E.

, McHugo,

G. J.

, Essock,

S. M.

, Bond,

G. R.

, Becker,

D. R.

, Wolfe,

, & Swain,

(2004). The Hartford study of supported employment for persons with severe mental illness. Journal of Consulting and Clinical Psychology, 72(3), 479–490. 10.1037/0022-006X.72.3.479.

27.

Patten,

M. L.

(2014), Understanding research methods9th ed.. Glendale, CA:Pyrczak Publishing.

28.

Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (2012). 2012 CMHS Uniform Reporting System Output Tables 1. U.S. Department of Health and Human Services.

29.

Thomson,

R. G.

(1997) Extraordinary bodies: Figuring physical disability in American culture and literature. New York, NY: Columbia University Press.

30.

Tyree,

, Kendrick,

M. J.

, & Block,

(2011). Strengthening the role of the employee: An analysis of supported employment using social role valorization theory. Journal of Vocational Rehabilitation, 35, 197–209.

Percentage of caseload capable of working part-time or full-time
Mental health professionals (N = 70) reported that 45% of their caseload is capable of part-time work and 23% is capable of full-time work.
Percentage of caseload employment is discussed
38 participants reported that they discuss employment with 50% or less of their caseload
32 participants reported that they discuss employment with 75–100% of their caseload
Challenges and successes of referring clients to employment specialists
Challenges	Success
48% reported the client’s	41% reported when refer to the employment specialists people go to work
•Fear of losing benefits
•Lack of childcare
•Non-compliance with treatment
22% reported the employment specialist
11% reported lack of transportation
10% reported lack of available jobs