No abstract

Highly significant reductions in service use were associated with steady employment. Given supported employment's well-established contributions to recovery, evidence of long-term reductions in the cost of mental health services should lead policy makers and insurers to promote wider implementation.

The Individual Placement and Support model of supported employment is one of the most robust interventions available for people with severe mental illness. Supported employment specialists deliver this intervention. There has been little research on what influences specialists' performance in the field. This paper redresses this deficit by documenting characteristics and competencies self-reported by specialists as influential to proficient performance in the field. Twenty-two qualitative interviews were conducted with specialists and their supervisors. Content analysis suggested the importance of eight factors: (1) initiative; (2) outreach; (3) persistence; (4) hardiness; (5) empathy; (6) passion; (7) team orientation (8) professionalism.

Concern over costs associated with mental disorders has led to an increase in the number of economic evaluations of treatment interventions; unfortunately, methods for measuring resource use have not kept pace with this concern. Although it is well-known that a significant proportion of the costs associated with mental illness are for resources other than treatment, program evaluators and researchers often count only treatment costs in cost-effectiveness comparisons. Further, existing methods for measuring resource use are plagued by faulty assumptions about resource use, poor validity and reliability, and difficulties quantifying resource use. The authors discuss these problems and suggest five ways of improving measurement of nontreatment resources: clarifying assumptions, using multiple data sources, flexible data collection strategies, methods for improving the accuracy of recall, and an episodic approach to measurement.

The results point to the need for greater uniformity in caseload measurement and help specify the costs of high-fidelity supported employment programs in real-world settings.