The authors compared 3 approaches to vocational rehabilitation for severe mental illness (SMI): the individual placement and support (IPS) model of supported employment, a psychosocial rehabilitation (PSR) program, and standard services. Two hundred four unemployed clients (46% African American, 30% Latino) with SMI were randomly assigned to IPS, PSR, or standard services and followed for 2 years. Clients in IPS had significantly better employment outcomes than clients in PSR and standard services, including more competitive work (73.9% vs. 18.2% vs. 27.5%, respectively) and any paid work (73.9% vs. 34.8% vs. 53.6%, respectively). There were few differences in nonvocational outcomes between programs. IPS is a more effective model than PSR or standard brokered vocational services for improving employment outcomes in clients with SMI.

Integrated treatment can be successfully delivered either by assertive community treatment or by standard clinical case management.

The research presented here reports on sustainability of the practices within the National Implementing Evidence Based Practices Project for people with serious mental illness. Forty-nine sites completed the initial 2-year implementation phase and were the focus of our study. Our aims were to discern the number of sites that sustained practices 2 years after implementation, the reasons for sustaining or not sustaining, differences in characteristics between the two groups, and the extent and nature of practice adaptations. We used a mixed-methods approach, based on a telephone survey that gathered qualitative and quantitative data from site representatives and others familiar with the sites and practices during the follow-up period. We found that 80% of sites sustained their practices for 2 years post-implementation, that sustainers differed from non-sustainers in several domains: financing, training, fidelity and agency leadership, and that most sites adapted practices moderately to meet state and local needs.

Implementation research has examined practice prioritization, implementation leadership, workforce development, workflow re-engineering, and practice reinforcement, but not addressed their relative importance as implementation drivers. This study investigated domains of implementation activities and correlated them to implementation success during a large national evidence-based practice implementation project. Implementation success was correlated with active leadership strategically devoted to redesigning the flow of work and reinforcing implementation through measurement and feedback. Relative attention to workforce development was negatively correlated with implementation. Active leaders should focus on redesigning the flow of work to support the implementation and on reinforcing program improvements.

Objective-The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1-year intensive skills training and health management, followed by a 1-year maintenance phase. To evaluate effects of HOPES on social skills and psychosocial functioning, a randomized controlled trial was conducted with 183 older adults with SMI (58% schizophrenia-spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual (TAU) with blinded follow-up assessments at baseline and 1-and 2-year follow-up. Results-Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to TAU in performance measures of social skill, psychosocial and community functioning, negative symptoms, and selfefficacy, with effect sizes in the moderate (.37-.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. Conclusions-The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program.Many individuals with severe mental illnesses (SMI) such as schizophrenia and treatmentrefractory mood disorders have prominent impairments in psychosocial functioning as they age (Bartels, Mueser, & Miles, 1997;Meeks & Murrell, 1997). Poor functioning in social relationships and independent living skills, combined with growing medical comorbidity (Druss, Bradford, Rosenheck, Radford, & Krumholz, 2000) and the loss of natural supports, makes this population highly vulnerable to long-term institutionalization in nursing homes and state hospitals (Meeks et al., 1990;Semke, Fisher, Goldman, & Hirad, 1996). Most older people with SMI live in the community (Meeks et al., 1990) and want to remain there (Bartels, 2003). In addition to the loss of independence and social dislocation inherent to institutionalization, the high cost of institutional care is concerning given the rapidly growing numbers of older people with SMI (Jeste et al., 1999). There is clearly a need to improve psychosocial functioning and to better prevent or manage chronic medical conditions of older Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim a...