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

1
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 DeLucaa aIndiana
University Purdue University Indianapolis and
bNew York Work Exchange

• 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.

Objective 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). Method Sample 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. Measures 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.
Procedures 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.  Results 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.) QSEIS Results
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).  Conclusions
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.
References 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.