Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Research documents the importance of work in the lives of people with mental health conditions (consumers), not only because of the financial security it brings but also because of its therapeutic impact on their health and well-being (Akabas & Kurzman, 2005). In response to these findings, providers of vocational services to consumers try to promote employment outcomes (Bond, et al., 2001). These efforts, however, have been minimally effective, in part because of the lack of understanding of the support that resolves the incompatibility between the needs of consumers and workplace demands (Lehman, et al., 2002; Gates, et al., 2005). As a result, consumers continue to experience low rates of job retention (Koch, & Rumrill, 2003). A qualitative, descriptive study was conducted to provide a better understanding of the support that best helps consumers sustain work. Methods: The New York State Office of Mental Health implemented a demonstration in 7 social service agencies to determine if performance based funding improved employment outcomes for consumers and promoted best practice among providers. As part of an evaluation of this effort, detailed activity logs were completed by line staff. Content analysis was performed on the logs to develop an understanding of which post placement supports were needed and their impact on retention. Analysis was completed on a sample of log entries for 171 consumers. Data from consumer surveys and provider tracking forms were merged with the log data to analyze the relationship between post placement support and other individual and employment factors. Results: On-going post placement supports contributed to consumers maintaining work. Those who received more support were less likely to lose employment and more likely to be working at the end of the demonstration. As predicted by social support theory, provider assistance was offered through emotional, informational, instrumental and feedback support. Emotional support or feedback were the most frequently offered. Support related to disclosing the mental health condition to supervisors and coworkers, or help around completing job tasks, maintaining job routines, developing relationships at work, or clarifying work hours and pay were also frequently offered. Support was often proactive to anticipate and prevent problems that might undermine job retention. Importantly, the need for support increased over time, and shifted in nature to support around career development and job satisfaction rather than help with meeting job requirements. The need for support was not related to individual characteristics including those associated with being harder to serve such as the severity of the mental health condition. Implications for Practice: Study findings have implications for developing the skills among providers to be most effective in assisting consumers sustain work and specifying the best practices for identifying the need for support and which supports are most appropriate. They also have implications for other at-risk populations (e.g., victims of domestic violence, aging workers, or those with physical disabilities) who face challenges to retaining employment and for whom work represents a source of well-being and meaning in their lives.