CLINICAL HANDBOOK OF SCHIZOPHRENIA

26. Vocational Rehabilitation 265and participate in regular treatment meetings (i.e., weekly) to coordinate services. Practitionersprovide information about how clients manage their illness, which helps to determinethe types of jobs and work settings that will support recovery. Employment specialists’ informationabout how a person is functioning at work informs treatment decisions. Ways toprovide integrated services include co-locating offices (i.e., employment specialists andmental health practitioners that share office space or have offices next to each other),maintaining an integrated client record, communicating frequently, and participating intreatment team meetings.4. Competitive employment is the goal. Employment specialists assist people in findingcompetitive jobs that are integrated in regular job settings. The position is “owned”by the client and is not set aside for people with disabilities. The client receives work supervisionand wage payment directly from the employer rather than from the mentalhealth or rehabilitation agency. The mental health agency allocates sufficient funds forsupported employment services and makes competitive employment a priority.5. The job search starts soon after a client expresses interest in working. People areassisted in finding jobs directly, and are not asked to participate in lengthy prevocationaltraining and assessment. Employment specialists spend several weeks meeting with clientsand collecting information to develop a vocational profile to identify job types and worksettings. Employment specialists initiate discussions with clients about whether to discloseto an employer information about their illness in relation to working. The client andemployment specialist devise a plan to find the desired job and to determine their respectiveresponsibilities in the job search. Some clients have difficulty making contact withemployers and choose to have the employment specialist take the lead.A central part of the employment specialist’s job duties is to develop relationshipswith employers. Employment specialists build a network of employers to help make goodjob matches that meet the needs of employers and clients. Employment specialists networkwith everyone they know (e.g., treatment team members, board members, familymembers, friends, friends of friends, community members, other employers) to identifyjob leads that are consistent with client preferences.6. Follow-along supports are continuous. Many people are able to find jobs but havedifficulties maintaining them. Individualized support provided by the client’s support networkcontinues for a time period that fits individual needs. The treatment team helps toidentify supports for starting a job, doing a job over time, having a problem on the job,and ending a job. Most supports are provided away from the job site.Job accommodations may help to improve a person’s job performance. For example,a person who has fearful thoughts when near a lot of people, can be helped by relocationof his or her work station. The cost of job accommodations for people with serious mentalillness is usually minimal.The employment specialist assists the client who is ending a job in planning for thenext work experience by incorporating information about previous work experiences toupdate the employment plan and moving forward.7. Client preferences are important. All aspects of supported employment are individualized.Decisions about types of work, work settings, amount of work, disclosure,job finding, and job support are made by the individual. Employment specialists help clientsto identify jobs that are consistent with their skills, experiences, and interests. Therefore,jobs are varied and may be found in diverse settings.In addition to following the evidence-based principles of supported employment, agenciesdevelop a culture that values work, healthy risk taking, access to information, and selfhelp.Supported employment services are provided through a team approach in which allpractitioners have a role in supporting people in their work efforts.