This publication briefly explains the philosophy upon which the Career Development Initiative (CDI) was developed. The CDI, sponsor by the New York State Office of Mental Health, works in collaboration with the Cornell University, Employment and Disability Institute to enhance the existing service delivery system in state-operated psychiatric centers providing vocational rehabilitation services

Blessing, Carol

English

DigitalCommons@ILR

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
Prepared by 
 
Carol Blessing, Faculty 
Employment and Disability Institute 
School of Industrial and Labor Relations 
Cornell University 
SHIFTING FROM 
TRADITIONAL TO 
EVIDENCE-BASED 
PRACTICES FOR PEOPLE 
WITH SEVERE MENTAL 
ILLNESS 
 
Spring 2003 
 
TRANSITIONS 
  
 
 
 
Acknowledgements 
The TRANSITIONS Series is produced by Cornell University’s Program on Employment 
and Disability.  This information series focuses on supporting the continued 
development and evolution of the educational paradigm in the United States.  
Specifically the ways in which we prepare youth with disabilities for successful adult 
living, learning and earning.  The author wishes to thank……… 
 
 
 
 
 
  
 
 
 
 
  Moving from………………………………………………..Moving toward 
 
Sheltered work………………………………………………Community work 
  
  
 
 
Most people with long-term mental illness are not employed at any level.  This is 
primarily because many people with a history of severe mental illness are not able to 
obtain and sustain jobs in the competitive market with no support and they are not 
interested in the generally low paying, repetitive jobs typically found in sheltered 
workshop settings (Ford, 1995).  Current research indicates, among other things, that 
most people with psychiatric disabilities want to be employed and that gainful 
employment in jobs that improve a person’s status results in higher levels of self-esteem 
and overall life satisfaction (SPI, Virginia Commonwealth University, 2001). 
 
A relative newcomer to the field known as Evidence-Based Vocational Practices is 
challenging the traditional service approaches available to people with severe mental 
illness.  Evidence-based practices are interventions for which there is consistent 
scientific evidence showing that they improve customer outcomes.  One of the six areas 
of evidence-based practices is supported employment.  Supported employment was 
originally developed for individuals with developmental disabilities who were 
considered to be “unemployable” or who needed a great deal of  “readiness” training if 
employment would ever be realized.  The supported employment framework was based 
on the following principles: 
? It is intended to serve individuals with the most severe disabilities in competitive 
community based employment options 
? Authentic integration with non-disabled workers will be an outcome 
? Work will occur on a minimum of a part-time basis (20 hours per week*) and 
workers will earn at least the prevailing minimum wage 
? The supported employee will receive ongoing support from the provider agency 
 
 
*This is a New York State standard. This standard can be waived for good reason if 
negotiated in the development of the Individualized Plan for Employment (IPE). 
 
 
Recent research shows that employment outcomes are higher for people who participate 
in programs that incorporate evidence-based principles that for people in programs that 
follow different principles, (Becker 2001).  Evidence-based supported employment 
practices follow six basic principles: 
 
 
Cornell University’s Employment and Disability Institute 
Proprietary Information Not for Dissemination 
 
 
2
 
1) Eligibility is based on customer choice 
2) Supported employment is integrated with mental health treatment 
3) Competitive employment is the goal 
4) Rapid job search is used 
5) Job finding is individualized 
6) Follow-along supports are continuous and ongoing 
 
This is a drastically different approach to supporting individuals who are living with 
severe mental illness.  Traditional treatment modalities incorporate a continuum 
approach to providing services and supports, requiring people to achieve some standard 
of performance at one stage prior to being granted opportunity to move to the next. This 
was based on the theory that wellness and social independence should precede efforts to 
obtain employment (Ford, 1995).  Evidence-based practices eliminate the need for 
people who are interested in work to “jump through the hoops” in order to the support 
necessary to get a job.  
 
The implementation of evidence-based practices or its equivalent will require a shift in 
the current system for the provision of supports and services to individuals who have 
severe mental illness.  Some critical elements for systemic change will include the need 
for: 
? Funding streams to be realigned to promote and support evidence-based 
supported employment services 
? Agency administrators to ensure that appropriate leadership, structural 
and financial supports are in place for the delivery of these services 
? Agency personnel to be provided the necessary technical knowledge and 
skills to provide quality supported employment services 
? People who receive services, family members and other advocates to be 
provided the necessary information and opportunity to practice self-
determined supported employment 
 
 
Agencies wishing to put forth the effort for system change will have to grapple with the 
obvious questions: 
 
WHERE TO START, WHO TO START WITH? 
Cornell University’s Employment and Disability Institute 
Proprietary Information Not for Dissemination 
 
 
3
 
HOW TO BUILD MOMENTUM?      WHAT’S IT GOING TO TAKE? 
 
HOW TO SUSTAIN AND REPLICATE ACTION?  
 
Cornell University’s Employment and Disability Institute 
Proprietary Information Not for Dissemination 
 
 
4
 
The New York State Office of Mental Health is on the brink of implementing its Career 
Development Initiative in collaboration with the Cornell University School of Industrial 
and Labor Relations’ Program on Employment and Disability.  The intent of the Career 
Development Initiative is to help facility-based vocational rehabilitation programs 
increase the amount and quality of successful employment outcomes for individuals 
receiving services by moving from an employer based system (where the jobs obtained 
are those offered within the facility) to service delivery system that facilitates 
community-based employment options. 
 
1.  Begin with those consumers who express a desire to work 
 √ Foster and facilitate principles of self-determination 
 √ Use person-centered practices as a vehicle for planning   
 √ Restructure treatment teams into support networks  
 
2. Build interest and demand for employment services 
 √Publicize successes 
 √Have employed participants mentor others 
 √Develop a family-to-family connections process for support 
 √Use community resources to support decision-making on issues such as effect of 
 wages on benefits   
 √Forge partnerships with the business community 
  
 
 
Becker, D. (2001). Implementing Supported Employment as an Evidence-Based Practice. 
 SPI Connections, Spring/Summer, 2-3. 
Ford, L.H. (1995).  Providing Employment Support for People with Long-Term Mental    
Illness Choices, Resources and Practical Strategies.  Baltimore: Paul H. Brookes Publishing Co. 
Connections: State Partnership Systems Change Initiative. (Spring/Summer 2001)  
Implementing Evidence-Based Vocational Practices for Serving People with 
Psychiatric Disabilities. Richmond: State Partnership Initiative (SPI), Virginia 
Commonwealth University.  
 
 
 
 
 
 
 
 
 
 
 
 


Shifting from traditional to evidence-based practices for people with severe mental illness

This publication briefly explains the philosophy upon which the Career Development Initiative (CDI) was developed. The CDI, sponsor by the New York State Office of Mental Health, works in collaboration with the Cornell University, Employment and Disability Institute to enhance the existing service delivery system in state-operated psychiatric centers providing vocational rehabilitation services.T7_PDF2.pdf: 567 downloads, before Oct. 1, 2020.0-T7_TXT1.txt: 35 downloads, before Oct. 1, 2020.1-T7_HTML.htm: 30 downloads, before Oct. 1, 2020

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Shifting from traditional to evidence-based practices for people with severe mental illness

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