Evaluating the fidelity of Taiwan’s Supported Employment program for people with mental illness and discussing the relationship between its’ fidelity and vocational outcome
Date Issued
2010
Date
2010
Author(s)
Chao, Kun-Lu
Abstract
Introduction. Most people with severe mental illness want to get jobs, but they could not find or maintain competitive employments because of the repetitive interference of psychiatric symptoms and social stigma. Supported Employment (SE) is a place-and-train model that helps people with severe mental illness to achieve the employment goal by concerning their preferences, skills, and experiences, as well as providing individual place and support service. Till now, SE has become the most evidence-based approach in helping people with severe mental illness to return to and stay in competitive work. SE services in Taiwan follow the 1980’s American SE model. There was no study to discuss the quality and effectiveness of the SE services for people with severe mental illness in Taiwan. Therefore, the purposes of this study are (1) to explore the quality and vocational outcomes of the SE services for people with severe mental illness by using the Supported Employment Fidelity Scale (SEFS); and (2) to explore the relationships between service quality and vocational outcomes.
Methods. Twenty agencies, which were responsible for government’s SE services for people with severe mental illness, were included in this study. Data collected through interviewing the agency’s employment specialists to get information about the personnel, organization, services, and vocational outcomes. The data was analyzed by using SPSS 11.5 for Windows by descriptive statistics, Mann-Whitney U, Spearman''s rho.
Results. By using SEFS, the fidelity scores were ranged from 74 to 103, which were greater than the criterion score of standardized SE. That means that all interviewed agencies meet the standards of the SE. Low integration of SE services with mental health treatment, not providing enough assertive engagement and outreach service, and poor relationship between employment specialists and employer were three major reasons that the interviewed agencies could not enter the Exemplary Fidelity level (score > 114). Compared to agencies reaching Fair Fidelity, agencies reaching Good Fidelity level got more scores in most SEFS items, and in which five items scores got statistically significant differences. Good Fidelity level agencies had better outcomes in every vocational outcome than Fair Fidelity level agencies; however, that did not make statistically significant difference. Most of the fidelity’s scores except item S13 (Community-based services) had statistically significant difference between medical and non-medical agencies. Medical agencies also had better outcomes in every vocational outcome than non-medical agencies, but there was no statistically significant difference. Results also showed that permanent employment rate had high correlation with competitive employment rate and every week’s work-hours in average.Providing time-unlimited follow-along supports & more permanent job had moderate correlation with average month’s payment.
Conclusion. SE services in Taiwan should enhance the integration of SE services and medical health treatment, provide more assertive engagement and outreach, and put more emphasis on interaction between employment specialists and employers to make better fidelity in SE for people with severe mental illness.
Subjects
Severe Mental Illness
Supported Employment
Fidelity
Vocational outcome
SDGs
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