Fidelity of supported employment programs and employment outcomes.

This study attempted to identify critical components of a supported employment program that were strongly correlated with competitive employment outcomes in a state mental health system. Researchers used a supported employment fidelity scale to rate programs at ten community mental health centers in Vermont. The staff at the centers concurrently assessed competitive employment outcomes for 2,639 clients who had been diagnosed as having severe and persistent mental illness. Higher competitive employment rates were strongly correlated with overall program fidelity and with two program components, namely, providing services in the community as opposed to providing them in the clinic and using full-time employment specialists as opposed to staff with mixed roles.

An overview of surveys of mental health consumers' preferences for housing and support services.

OBJECTIVE: The author examined the methodology and results of studies that surveyed mentally ill clients' preferences related to housing and support services to gain an overview of demographic characteristics, current and preferred housing situations, and preferred types of staff supports and social and material supports in a nationally representative sample of clients. METHODS: Through mailings to state departments of mental health and local mental health providers and advocates, a national survey of residential providers, and other contacts with mental health agencies, the author identified a total of 43 studies of mental health consumers' preferences for housing and supports conducted between 1986 and 1992. The results of 26 of the studies whose methodologies permitted comparison of findings were summarized. RESULTS: Consumers consistently reported that they would prefer to live in their own house or apartment, to live alone or with a spouse or romantic partner, and not to live with other mental health consumers. Consumers reported a strong preference for outreach staff support that is available on call; few respondents wanted to live with staff. Consumers also emphasized the importance of material supports such as money, rent subsidies, telephones, and transportation for successful community living. CONCLUSIONS: To accommodate consumers' preferences, mental health systems should work toward providing flexible supports corresponding to the episodic nature of psychiatric disability and should expand their advocacy for affordable housing and for increased income for people who depend on disability benefits and other entitlements.