Adapting Evidence-Based Interventions to Fit Usual Practice: Staff Roles and Consumer Choice in Psychiatric Rehabilitation

Abstract

This proof-of-concept study tested the viability of adapting a specialized practice to fit multi-service programs by switching from specialist to generalist staff roles. The intervention under study was supported employment, an evidence-based practice for adults with severe mental illness. Program data on participant characteristics, attendance, staff contact, and employment were retrieved for the 2007 calendar year (N = 99). Two hierarchical regression analyses compared (1) participants with any versus no mainstream employment, and (2) participants who started a new job in 2007 versus all other participants. In both analyses, individual participant counts of days on which employment services were provided and count of different employment service providers independently predicted mainstream employment over and above program attendance and background factors. The study program's employment rate approximated rates published for specialized supported employment programs, suggesting that it is feasible to adapt specialized evidence-based practices to fit multi-service settings without compromising service quality.

Continued Use of Evidence-Based Treatments After a Randomized Controlled Effectiveness Trial: A Qualitative Study

“…The results of this study are consistent with previous studies that have documented organizational (28)(29)(30)(31), provider-based (9,(32)(33)(34), and clientbased (9,35) barriers or constraints to the implementation of evidencebased treatments and practices. They are also consistent with previous studies that have focused on adaptations of evidence-based treatments to accommodate the needs of clients belonging to specific age (36) or racial-ethnic (37) groups, provider preferences (38), or organizational context (39).…”

Supported employment: Meta-analysis and review of randomized controlled trials of individual placement and support

“…There have also been efforts to expand how IPS is done. For example, one study looked at expanding SE beyond the rigid requirements of IPS [67]. Instead of using specialized IPS delivery centers, these researchers were able to show that IPS can be effectively delivered in a ‘multi-server’ program center.…”

Social Value of Supported Employment for Psychosocial Program Participants

“…A prior study of this same program demonstrated that SE services can be effectively provided by psychosocial program professionals practicing as generalists [53], and this program's 2008 and 2009 quarterly employment rates were similar to the quarterly rates reported for other SE programs [57], so it seems reasonable to recommend that psychosocial programs designed to promote both peer support and social integration add supported employment to their array of rehabilitation services.…”

“…The program is also open as a drop-in center on weekends. Job-hunting assistance and on-job support for Waverley Place members are provided primarily through one-on-one interactions with Waverley Place staff [53] One-on-one supported employment services include newspaper and internet searches, social networking for job leads and references, resume preparation, interview coaching and practice, job-related skill and travel training, and work-focused supportive counseling, including discussions of social security benefits, income budgeting, family expectations, time management, and job pressures. All program members are invited to join a weekly employment support group where they can share their own accomplishments and experiences, and gain insights and job information from other members.…”