Supported employment is integrated with mental health treatment.

Employment specialists meet frequently with the mental health treatment team.

Transcript

The second principle is that supported employment should be integrated with the mental health treatment that is received by each consumer. Among other things, this means that supported employment is unlikely to be effective if a consumer is not concurrently receiving adequate clinical case management. Employment specialists should be in frequent communication with mental health case managers and attend their consumers’ team meetings. To accomplish this, it is best that the supported employment team and the mental health treatment team be part of the same agency.

However, there is more involved than simply having the mental health treatment team and the supported employment staff at the same location. There must be genuine collaboration and mutual problem-solving. The evidence for this principle comes from 7 experimental comparisons of integrated approaches with “brokered” approaches”. Brokered approaches are programs in which vocational services are provided by a separate agency or team that is not involved with the mental health treatment program.

Another source of evidence for this principle comes from qualitative studies. These studies have found that brokered approaches have problems related to miscommunication between programs. Meetings may be harder to schedule due to the distance between programs. Mental health treatment teams are less likely to make as many referrals when the supported employment team is not “owned” by the treatment team. Another problem is that the treatment team is focusing on the consumer’s symptoms, while the employment team is focusing on the consumer’s strengths and capabilities, so the disparate perceptions get in the way of collaboration. When services are brokered, it is more likely that case management services will be poorly timed with vocational plans. For example, medication or housing changes should always be coordinated with employment changes, but this is harder to maintain in a brokered approach. Responsibility for follow-up is often unclear, and employment staff may be caught up doing crisis intervention, which is the case manager’s role.

Studies have found advantages to the integrated approach that are the mirror image of the disadvantages. Dropout rates are lower in integrated approaches, because case managers are involved in keeping consumers engaged. Clinicians and employment specialists report better communication. Clinicians become involved and excited about employment, and the close working relationship between the clinicians and the employment team results in clinical information becoming a part of the vocational plan.