Barriers in the brokered model of supported employment for persons with psychiatric disabilities

Abstract

In the traditional brokered model of vocational rehabilitation for persons with psychiatric disabilities, mental health and vocational services are provided in separate agencies. Problems in this model have frequently been described in the literature but without client-level data. In a controlled clinical trial, clients assigned to a ‘best practice’ exemplar of the brokered model achieved vocational outcomes that were inferior to those of clients assigned to a model that integrated mental health and vocational services within the same program. In this paper, process data are examined to clarify the relatively poor performance of the broke red model. A large proportion of the clients who were assigned to the brokered model (38%) either failed to engage with the vendor or to complete the preemployment skills training phase. For clients who had difficulty engaging and for those who did engage and complete the preemployment phase, problems related to coordination between the mental health program and the vocational vendor were common and negatively affected outcomes. This analysis supports a more fundamental integration of mental health and vocational services than is characteristic of the brokered model.