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New York City Supported Employment Programs for People with Severe Mental Illness: Are They Implementing Evidence-Based Principles?Gary R. Bond,a Lisa J. Evans,a Dan Del Bene,b Alysia Pascaris,b Shaleigh Tice,b Debbi Talbott,b Kikuko Yamamoto,a & Natalie DeLucaaaIndiana University Purdue University Indianapolis and bNew York Work Exchange
The objective of this study was to provide descriptive information regarding the types of supported employment (SE) services being provided to people with severe mental illness (SMI) in New York City (NYC). We used as our framework a set of SE principles validated in research and practice over the past 15 years (Bond et al., 2001).
As part of an ongoing project, we have surveyed 72 employment programs for people with SMI in NYC. A total of 29 SE programs in operation for 6 months or more are included in this report.
The Quality of Supported Employment Implementation Scale (QSEIS) is a 33-item interviewer-rated instrument developed to measure implementation of the evidence-based principles of SE programs. The QSEIS was developed by an expert panel (Bond et al., 2000). Each response is rated on a 5-point behaviorally-anchored scale, with a score of 5 indicating full adherence to SE standards, 4 indicating moderate implementation, and the remaining scale points indicating increasingly larger departures from evidence-based practice. The QSEIS has been factor analyzed, yielding four factors: Integration, Assessment and Engagement, Teamwork, and Job Placement.
Background information was also collected on each program including borough of program, date of startup, funding sources, number of full-time staff, number of active clients, number of clients in competitive jobs, and population type.
Staff from the New York Work Exchange interviewed directors from each SE program. At least two trained raters were present for all interviews. Raters scored the programs individually and reached consensus on any discrepancies after the interview. Previous research has established satisfactory inter-rater reliability for these procedures. On average, the interviews took approximately 60 minutes to complete.
Program Characteristics and Employment Outcomes
Of the 29 NYC SE programs surveyed, 15 were in Manhattan, 4 in the Bronx, 5 in Brooklyn, and 5 in Queens. On average, the programs had been in operation for 4.1 years and had 11 SE staff and 46 active clients. The majority of the programs (90%) served only persons with an SMI diagnosis.
At the time of the survey, programs reported that an average of 28 clients were currently competitively employed (60% of active SE clients in these programs). This competitive employment rate is higher than that for Kansas (49%) and similar to New Jersey (60%). (Employment data were not available from Maryland.)
Mean ratings on QSEIS items for the NYC SE programs, compared to 3 other states, are shown in the Table 1. Overall, NYC SE programs showed several areas of strengths and weaknesses, as highlighted in color. Figure 1 reports mean implementation based on the factor scores. NYC excelled in implementation of Teamwork, but scored significantly lower on the Assessment and Engagement factor than the 3 comparison states and on the Integration and Job Placement factors than 2 of the 3 comparison states. Figure 2 reports the number and percentage of programs achieving mean total QSEIS scores exceeding cut-offs of 4.3 (for “approaching full implementation”) and 4.0 (for “moderate implementation”): none of the NYC programs achieved a mean score of 4.3 with 86% scoring less than 4.0, suggesting gaps in SE implementation.
Program size, location, and time in existence were unrelated to SE implementation, as measured by the QSEIS. In addition, neither the QSEIS total score nor any of the factors predicted the percentage of clients competitively employed (in either the total sample or the NYC sample).
Supported employment programs in NYC are reporting an encouraging rate of competitive employment for the clients with SMI and they excelled in functioning as teams; however, there are a number of other areas needing improvement in order to achieve full implementation. These findings may help inform discussions within NYC about improving quality of employment services for consumers with SMI.
We surveyed 29 supported employment (SE) programs for people with severe mental illness (SMI) in New York City using the Quality of Supported Employment Implementation Scale (QSEIS), a 33-item scale based on evidence-based principles of supported employment (Bond et al., 2001). Previously we used the QSEIS to survey SE programs in three other states, providing a comparison for the NYC sample. We report summary information for the city as a whole. Several noteworthy strengths of the NYC programs included an emphasis on permanent jobs in diverse settings, appropriate caseload sizes, and extensive follow-along. According to evidence-based principles, gaps in the NYC SE programs included program elements related to integration of mental health and employment services, rapid job search, and ready access for consumers indicating a desire for competitive employment. These findings may help inform discussions within NYC about improving quality of employment services for consumers with SMI.
Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A., Meisler, N., Lehman, A. F., Bell, M. D., & Blyler, C. R. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52, 313-322.
Bond, G. R., Picone, J., Mauer, B., Fishbein, S., & Stout, R. (2000). The Quality of Supported Employment Implementation Scale. Journal of Vocational Rehabilitation, 14, 201-212.