The Quality of Supported Employment Implementation Scale

The authors describe a 33-item interviewer-rated checklist, the Quality of Supported Employment Implementation Scale (QSEIS), designed to measure implementation of supported employment (SE) programs for people with severe mental illness (SMI). They used a 1.5-hour semi-structured interview with program directors in 32 SE programs in Kansas (KS) and New Jersey (NJ). Interviewers averaged 84% agreement in item ratings. The internal consistency for the total scale was low (Cronbachs alpha = .51), but higher for four subscales: Teamwork (.74), Planning and Support (.60), Rapid Job Search (.74), and Integration with Mental Health (.62). Substantial implementation of SE standards was found in these programs, with mean ratings exceeding 4.0 on a 5-point scale, for 18 of 33 items. Mean overall implementation was similar in both states, with somewhat different patterns, with NJ rating higher on Planning and Support, and KS rating higher on Integration of Mental Health and Rapid Job Search. The QSEIS total scale and 4 subscales were correlated with 9 indicators of employment outcomes, obtained from a retrospective survey completed by program directors in 24 of the programs. The total QSEIS score was not significantly correlated with any of the outcome measures. Planning and Support correlated positively with job tenure (r = .62), but was not related to annual VR closure rate (r = -.15). Conversely, Rapid Job Search was negatively correlated with job tenure (r = -.56), while positively correlated with annual VR closure rate (r = .46). Thus different aspects of the supported employment approach may foster job acquisition and job retention. The authors conclude that the QSEIS is a pragmatic tool for describing SE programs for people with SMI, although more work on psychometric precision and predictive validity is needed. The survey provides norms by which other providers and other states can compare their achievement of the principles of supported employment. INTRODUCTION Introduced in the 1980s (Wehman, 1986), supported employment (SE) is an approach to helping people with severe disabilities work in competitive employment positions. Although its principles are well described in the literature, its implementation has been variable throughout the U.S. In this project, the authors sought to develop a checklist that concretely measures features of well-implemented SE programs. Although the current focus is on developing a scale applicable for programs serving people with severe mental illness (SMI), the ultimate goal is to develop companion scales for other disability groups. Scales to measure quality of supported employment implementation are of interest to consumers, providers, and administrators. The recent Rehabilitation Act Amendments explicitly note the role of state VR agencies in helping consumers acquire  information necessary to make an informed choice about the specific services, including the providers of those services, that are needed to achieve the individuals vocational goal. This information must include, at a minimum, information relating to cost, accessibility, and duration of potential services, the consumer satisfaction with those services, the qualifications of potential service providers, the types of services offered by those providers, and the degree to which services are provided in