...medications that better control symptoms, allowing consumers assume work roles; laws that protect consumers from discrimination and tie funding streams to work outcomes (ADA PL 101-336; TWWIIA PL 106-170); pressure from the consumer movement (Steele & Berman, 2001); and employers' willingness to diversify their workforce.

Although support for employment is strong, providers have not caught up with recommendations of treatment efficacy (Wolf-Branigin, Daischlein, Cardinal, & Twiss, 2000). In a study by the Schizophrenia Patient Outcomes Research Team (PORT) of conformance rates by professionals, of twelve current care recommendations, offering vocational rehabilitation had the next to lowest rate at 22.5% (Lehman et al., 1998).

This article uses the Work Opportunities for Rewarding Careers (WORC) Program, a program based on current evidence and best practices, to identify the obstacles and promoting forces to achieving employment outcomes. It describes the WORC Program, discusses factors that affect its implementation, its impact on the policies and practices of social service agencies in which it has been implemented, and implications for future program development.

Vocational Best Practices and the WORC Program

The WORC Program goal is to help consumers secure competitive jobs in the community, jobs that pay at least minimum wage and where co-workers are primarily people without disability. The WORC Program combines evidence based practices in a systems approach, helping mental health consumers make life long connections to the world of work that meet their career interests and promote their well-being and helping employers make connections to a source of workers that meets their labor force needs. The program uses an approach to providing employment services called Supported Employment (SE). Like most SE programs, the WORC Program helps consumers through a process common to anyone securing and sustaining work, regardless of disability status, including identifying a career path, selecting a job along that path, finding and securing such a job, maintaining that job, and then, if desired, transitioning to another job along the career path. Like most SE programs, the WORC Program also provides the unique vocational support needed by consumers because of the way their mental health conditions interact with the employment process.

Research helps to identify the types of services and supports that are most effective in helping consumers reach their vocational goals (Corrigan, Steiner, McCracken, Blaser, & Barr, 2001). These include:

Coordinated services: Often mental health services are provided independently of vocational services, with little communication between the clinician and employment specialist. As a consequence, consumers can find themselves caught between contradictory advice when clinicians counsel that the consumer is not ready for work while the employment specialists encourage the consumer to seek a job. Studies comparing outcomes provided through brokered services to teams where vocational and mental health services are integrated, such as through Assertive Community Treatment (ACT) teams, find job placement and retention more likely with an integrated approach (Bond, 1998; Phillips et al., 2001), suggesting that integrated clinical and vocational services lead to improved planning and remove the burden of coordination from the consumer.

Service coordination, however, is broader than integration of clinical and vocational services. Consumers typically experience a range of issues (for example, unstable housing, involvement in the criminal justice system, domestic violence, lack of transportation, and physical health problems, among others) that could pose barriers to work and, therefore, need attention as they move into employment. Additionally, the state vocational rehabilitation agency needs to coordinate with an SE program, assisting consumers with needs not covered by the SE program, including training, uniform costs, or transportation to work. Current findings confirm the experience of mental health service providers that work outcomes are enhanced when services that remediate such potential barriers to employment are coordinated with vocational services (Akabas & Gates, 2000; Gates et al., 2004).

Limited pre-vocational activities: Based on research that shows that the longer consumers remain in work readiness activities the less likely they will be to actually get a job (Bond, 1998; Gowdy, Carlson, & Rapp, 2003), best practice SE programs take a "place and train" approach. When a consumer indicates interest in work, the program actively begins a job search process and only focuses on skill training once the consumer is employed.

Individualized services: Not surprisingly, people with mental health conditions, like most people, do not stick with work that they do not like. Research shows that the most effective employment outcomes are achieved when jobs are matched to individual interests and accommodations are identified with respect to an individual's specific job (Bond et al., 2001; Gates et al., 2004). Psychosocial assessment focused on psychiatric history and symptom status is insufficient for informing a good match between the consumer and the job (Ridgeway & Rapp, 1999; see also Dorio, 2004, Gates, 2000). Rather, through individual comprehensive assessment, interests, skills, and abilities need to be identified and gaps in functional capacity determined with respect to a...

NOTE: All illustrations and photos have been removed from this article.



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