Supported Employment and

Models.
CICIL R VASANTHRA
2nd Mphil PSW
Introduction
• 70% of adults with SMD desire to work (Mueser et al, 2001)
• A world wide approach to Vocational rehab for PwD who are unable to
gain / retain employment.
• For those with disabilities of:
• Intellectual
• Emotional
• Physical
• Philosophy of SE is that every person with SMD is capable of
competent work if right kind of job and work environment can be
found.
SMD a barrier to employment
• Cognitive impairments
• Social Skills deficits
• Clinical symptoms – impaired judgement, poor attn & conc, etc
• Negative symptoms
• Episodic nature of disorders
• Side effects of medicines
• Low vocational expectations by health professionals
• Community & workplace stigma
• Career immaturity
SE approach
• Extensive prevocational training makes “perfect workers”.
• SE capitalises on personal strengths and motivation for creating “natural
fit”.
• Prevocational assessment & training is not a priority in SE
• Job search at the pace of the client –
• Type of work preferred,
• Nature of support they want and
• Decisions about whether to disclose their MI to employers or co-workers.
• Long term support + employment = better evidence
• self perception, less stigma, social acceptance
 Principles (Bond, 2004)
1) Eligibility based on consumer choice

2) Integration of vocational rehabilitation with mental health care

3) A goal of competitive employment

4) Rapid commencement of job search activities

5) Service based on consumer preference

6) Continuing support to retain employment (McHugo, 1998 – 3.5 yr fu, 78% vs. 28%)

7) Income support and health benefits counselling

Definition
SE means competitive employment in an integrated setting with ongoing support
services for individuals with the most severe disabilities – (A) for whom
competitive employment has not traditionally occurred or for whom competitive
employment has been interrupted or intermittent as a result of severe disability;
and (B) Who, because of the nature and severity of their disabilities, need
intensive support employment services from the designated state unit and
extended services after transition in order to perform this work; or (ii)
Transitional employment for individuals with the most severe disabilities due to
mental illness.
MODELS OF SE
• CLUB HOUSE
• TRASITIONAL EMPLOYMENT
• SOCIAL FIRMS
• NON- INTEGRATED PRE-VOCATIONAL SERVICES
• SHELTERED WORK
CLUBHOUSE
• Work ordered days in rehab environment.
Transitional Employment
• On - the – job training
• Clubhouse model for those with lack of work experience, confidence
or work skills, and the opportunity to work in real jobs for real pay.
• 6 – 9 months of temporary work
• Award wages
• Employer’s place of business is the venue of work
• No resume, no interview
SOCIAL FIRMS
• Italy, 1960
• Common in Europe and UK
• Not for profit business for PwD
• 20-50% positions to PwD
• Productivity based wages
• Equal employment opportunities
• Majority income generation through commercial business
Non- integrated pre-vocational services
• Stepwise “train and place”
• Vocational training covering generic work skills + personal
development
Sheltered Work
• PLMI with low level of functioning
• Not ready to participate in work
• Piece rate or achievement based pay which is usually low.
• Repetitive and monotonous work
• Time unlimited
• Sheltered often in Psychiatric institutions
 Job Coach Models
• JOB Coach model:
1. Assist find a job
2. Vocational support on and off site
3. Community plays key role than MHP
Choose- Get – Keep - Leave
• Choose a job that is compatible with needs, interest, experience and
personal values.
• Trained to get the appropriate job
• Prepare for job interviews – resume, interview skills, negotiation terms
• Ongoing support to keep the job.
• Future employment
Assertive Community Treatment
• Interdisciplinary team

• Intensive case management

• Decrease hospitalization and increase housing

Individual Placement and Support Model (IPS)
• Vocational and clinical services integration
• A combination of ACT + Choose – Get – Keep – Leave models
• PRINCIPLES
1. Competitive employment as the goal
2. Rapid job search
3. Integration of rehab and mental health
4. Attention to consumer preferences
5. Continuous and comprehensive assessment
6. Time unlimited support
The Menu Approach
• Village Integrated Service Agency (ISA), Los Angeles Country,
California.
• PRINCIPLES:
1. “Pay the bills” and beyond – sense of purpose, social interaction,
opportunity to contribute to the community.
2. Participate in and benefit from meaningful paid work.
3. Consumers should be able to choose form a “menu” of employment
options.
4. Experience in different kind is of paid work is an important part of
developing long term employment in competitive setting
 Assessment of vocational potential

• Daily functioning

• Job related social skills

• Job related cognitive skills eg.,memory, task completion, attention,

planning, task specific decision making.
• Work behaviour: punctual, Regularity, Task initiatives, Manage conflicts,
flexibility

• Job readiness: Willingness/motivation, adherence to treatment, side

effects, symptoms, insight

• Job related details

• Family client matters