Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Supported Employment

SUPPORTED EMPLOYMENT FIDELITY SCALE*

Rater:

Site:

Date:

Total Score:

Directions: Circle one anchor number for each criterion.

Criterion	Data Source**	Anchor
STAFFING
1. Caseload size: Employment specialists manage vocational caseloads of up to 25 clients.	VL, MIS, DOC, INT	1 = Ratio of 81 or more clients/employment specialist. Or Cannot rate due to no fit.
		2 = Ratio of 61-80 clients/employment specialist.
		3 = Ratio of 41-60 clients/employment specialist.
		4 = Ratio of 26-40 clients/employment specialist.
		5 = Ratio of 25 or less clients/employment specialist
2. Vocational services staff: Employment specialists provide only vocational services.	MIS, DOC, INT	1 = Employment specialists provide nonvocational servicessuch as case management 80% of the time or more. Or Cannot rate due to no fit.
		2 = Employment specialists provide nonvocational services such as case management about 60% time.
		3 = Employment specialists provide nonvocational services such as case management about 40% time.
		4 = Employment specialists provide nonvocational services such as case management about 20% time.
		5 = Employment specialists provide only vocational services.
3. Vocational generalists: Each employment specialist carries out all phases of vocational service, including engagement, assessment, job placement, and follow-along supports.	VL, MIS, DOC, INT	1 = Employment specialist only provides vocational referral service to vendors and other programs. Or Cannot rate due to no fit.
		2 = Employment specialist maintains caseload but refers clients to other programs for vocational service.
		3 = Employment specialist provides one aspect of the vocational service (e.g. engagement, assessment, job development, job placement, job coaching, and follow-along supports).
		4 = Employment specialist provides two or more phases of vocational service but not the entire service.
		5 = Employment specialist carries out all phases of vocational service (e.g. engagement, assessment, job development, job placement, job coaching, and follow-along supports).

* Formerly called IPS Model Fidelity Scale
** See end of document for key

ORGANIZATION
1. Integration of rehabilitation with mental health treatment: Employment specialists are part of the mental health treatment teams with shared decision making. They attend regular treatment team meetings (not replaced by administrative meetings) and have frequent contact with treatment team members.	VL, MIS, DOC, INT	1 = Employment specialists are part of a vocational program, separate from the mental health treatment. No regular direct contact with mental health staff, only telephone or one face to face contact per month. Or Cannot rate due to no fit.
		2 = Employment specialists attend treatment team meetings once per month.
		3 = Employment specialists have several contacts with treatment team members each month and attend one treatment team meeting per month.
		4 = Employment specialists are attached to one or more case management treatment teams with shared decision making. Attend weekly treatment team meetings.
		5 = Employment specialists are attached to one or more case management treatment teams with shared decision making. Attend one or more treatment team meetings per week and have at least three client-related case manager contacts per week.
2. Vocational unit: Employment specialists function as a unit rather than a group of practitioners. They have group supervision, share information, and help each other with cases.	MIS, INT	1 = Employment specialists are not part of a vocational unit. Or Cannot rate due to no fit.
		2 = Employment specialists have the same supervisor but do not meet as a group.
		3 = Employment specialists have the same supervisor and dis- cuss cases between each other. They do not provide services for each other’s cases.
		4 = Employment specialists form a vocational unit and discuss cases between each other. They provide services for each other’s cases.
		5 = Employment specialists form a vocational unit with group supervision at least weekly. Provide services for each other’s cases and backup and support for each other.
3. Zero exclusion criteria: No eligibility requirements such as job readiness, lack of substance abuse, no history of violent behavior, minimal intellectual functioning, and mild symptoms.	DOC, INT	1 = Clients are screened out on the basis of job readiness, substance use, history of violence, low level of functioning, etc. Referrals first screened by case managers. Or Cannot rate due to no fit.
		2 = Some eligibility criteria. Screened by vocational staff who make client referrals to other vocational programs.
		3 = Some eligibility criteria. Screened by vocational staff of the program that will provide the vocational service.
		4 = All adult clients with severe mental disorders are eligible, including dual disorders of substance abuse and mental illness. Services are voluntary.
		5 = All clients are encouraged to participate. Referrals solicited by several sources (self-referral, family members, self-help groups, etc.).

SERVICES
1. Ongoing, work-based vocational assessment: Vocational assessment is an ongoing process based on work experiences in competitive jobs.	DOC, INT	1 = Vocational evaluation is conducted prior to job placement with emphasis on office-based assessments, standardized tests, intelligence tests, work samples. Or Cannot rate due to no fit.
		2 = Client participates in a prevocational assessment at the program site (e.g. work units in a day program).
		3 = Assessment occurs in a sheltered setting where clients carry out work for pay.
		4 = Most of the assessment is based on brief, temporary job experiences in the community that are set up with the employer.
		5 = Vocational assessment is ongoing. Occurs in community jobs rather than through a battery of tests. Minimal testing may occur but not as a prerequisite to the job search. Aims at problem solving using environmental assessments and consideration of reasonable accommodations.
2. Rapid search for competitive job: The search for competitive jobs occurs rapidly after program entry.	DOC, INT, ISP	1 = First contact with an employer about a competitive job is typically more than one year after program entry. Or Cannot rate due to no fit.
		2 = First contact with an employer about a competitive job is typically at more than nine months and within one year after program entry.
		3 = First contact with an employer about a competitive job is typically at more than six months and within nine months after program entry.
		4 = First contact with an employer about a competitive job is typically at more than one month and within six months after program entry.
		5 = First contact with an employer about a competitive job is typically within one month after program entry.
3. Individualized job search: Employer contacts are based on clients’ job preferences (relating to what they enjoy and their personal goals) and needs (including experience, ability, health, etc., and how they affect a good job and setting match) rather than the job market (i.e., what jobs are readily available).	DOC, INT, ISP	1 = Employer contacts are based on decisions made unilaterallyby the employment specialist. These decisions are usually driven by the nature of the job market. Or Cannot rate due to no fit.
		2 = About 25% employer contacts are based on job choices which symptomotology, and reflect client’s preferences, strengths, symptoms, etc., rather than the job market.
		3 = About 50% employer contacts are based on job choices which reflect client’s preferences, strengths, symptoms, etc., rather than the job market.
		4 = About 75% employer contacts are based on job choices which reflect client’s preferences, strengths, symptoms, etc., rather than the job market.
		5 = Most employer contacts are based on job choices which reflect client’s preferences, strengths, symptoms, etc., rather than the job market.
4. Diversity of jobs developed: Employment specialists provide job options that are different settings.	DOC, INT, ISP	1 = Employment specialists provide options for either the same types of jobs for most clients, e.g., janitorial, or jobs at the same diverse and are in work settings most of the time. Or Cannot rate due to no fit.
		2 = Employment specialists provide options for either the same types of jobs, e.g., janitorial, or jobs at the same work settings about 75% of the time.
		3 = Employment specialists provide options for either the same types of jobs, e.g., janitorial, or jobs at the same work settings about 50% of the time.
		4 = Employment specialists provide options for either the same types of jobs, e.g., janitorial, or jobs at the same work settings about 25% of the time.
		5 = Employment specialists provide options for either the same types of jobs, e.g., janitorial, or jobs at the same work settings less than 10% time.
5. Permanence of jobs developed: Employment specialists provide competitive job options that have permanent status rather than temporary or time-limited status, e.g., TEPs.	DOC, INT, ISP	1 = Employment specialists usually do not provide options for permanent, competitive jobs. Or Cannot rate due to no fit.
		2 = Employment specialists provide options for permanent, competitive jobs about 25% of the time.
		3 = Employment specialists provide options for permanent, competitive jobs about 50% of the time.
		4 = Employment specialists provide options for permanent, competitive jobs about 75% of the time.
		5 = Virtually all of the competitive jobs offered by employment specialists are permanent.
6. Jobs as transitions: All jobs are viewed as positive experiences on the path of vocational growth and development. Employment specialists help clients end jobs when appropriate and then find new jobs.	VL, DOC, INT, ISP	1 = Employment specialists prepare clients for a single lasting job, and if it ends, will not necessarily help them find another one. Or Cannot rate due to no fit.
		2 = Employment specialists help clients find another job 25% time.
		3 = Employment specialists help clients find another job 50% time.
		4 = Employment specialists help clients find another job 75% time.
		5 = Employment specialists help clients end jobs when appropriate and offer to help them all find another job.
7. Follow-along supports: Individualized follow-along supports are provided to employer and client on a time-unlimited basis. Employer supports may include education and guidance. Client supports may include crisis intervention, job coaching, job counseling, job support groups, transportation, treatment changes (medication), networked supports (friends/family).	VL, DOC, INT	1 = Follow-along supports are nonexistent. Or Cannot rate due to no fit.
		2 = Follow-along supports are time-limited and provided to less than half of the working clients.
		3 = Follow-along supports are time-limited and provided to most working clients.
		4 = Follow-along supports are ongoing and provided to less than half the working clients.
		5 = Most working clients are provided flexible follow-along supports that are individualized and ongoing. Employer supports may include education and guidance. Client supports may include crisis intervention, job coaching, job counseling, job support groups, transportation, treatment changes (medication), networked supports (friends/family).
8. Community-based services: Vocational services such as engagement, job finding and follow-along supports are provided in natural community settings.	VL, MIS,DOC, INT	1 = Employment specialist spends 10% time or less in the community. Or Cannot rate due to no fit.
		2 = Employment specialist spends 11-39% time in community.
		3 = Employment specialist spends 40-59% time in community.
		4 = Employment specialist spends 60-69% time in community.
		5 = Employment specialist spends 70% or more time in community.
Assertive engagement and outreach: assertive engagement and outreach (telephone, mail, community visit) are conducted as needed.	VL, MIS, DOC, INT	1 = Employment specialists do not provide outreach to clients as part of initial engagement or to those who stop attending the vocational service. Or Cannot rate due to no fit.
		2 = Employment specialists make one telephone or mail contact to clients as part of initial engagement or to those who stop attending the vocational service.
		3 = Employment specialist makes one or two outreach attempts (telephone, mail, community visit) as part of initial engage- ment and also within one month that client stops attending the vocational service.
		4 = Employment specialist makes outreach attempts (telephone, mail, community visit) as part of initial engagement and at least every two months on a time limited basis when client stops attending.
		5 = Employment specialists provide outreach (telephone, mail, community visit) as part of initial engagement and at least monthly on a time unlimited basis when clients stop attending the vocational service. Staff demonstrate tolerance of different levels of readiness using gentle encouragement.

*Data sources:

VL..............Vocational Logs
MIS............Management Information System
DOC...........Document review: clinical records; agency policy and procedures
INT.............Interviews with clients, employment specialists, mental health staff
ISP..............Individualized Service Plan

2/14/96
6/20/01, Updated

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