Individuals with psychiatric disabilities maintain 10% to 15% employment rates and report shorter job retention rates when compared to the general population (Anthony, Cohen, Farkas, & Gagen, 2002; Bricout, 2002; National Alliance for Mental Illness [NAMI], 2004). Despite low employment rates, individuals with psychiatric disabilities report a desire to work and consider employment an important recovery goal (Cook & Pickett, 1995; Crowther, Marshall, Bond, & Huxley, 2001; McQuilken et al., 2003; Mueser, Salyers, & Muser, 2001; Anthony & Rogers, 1995; Rogers, Walsh, Masotta, Danley, & Smith, 1991). Further, studies have demonstrated that employment decreases financial strain on mental health systems, reduces poverty, improved quality of life, increases self-esteem, and plays an important role in psychological health and social well-being (Arns & Linney, 1993; Baron, 2000; Lehman et al., 2002; Mueser et al., 1997).
Groups participating in Evidence-Based Supported Employment (EBSE) demonstrate a significant increase in work, between 40% and 60% employment rates (Crowther et al., 2001; Lehman et al., 2002; Bond et al., 2001; Cook & Razzano, 2000; Rogers, Anthony, Toole, & Brown, 1991; Becker & Drake, 1993, 2003; Bond, 1998, 2004; Bond, Drake & Becket, 1999; Drake, Becker, Biesanz, Wyzik, & Torrey, 1996; Honey, 2000; Lehman, 1995; Schneider, Heyman, & Turton, 2002). Five randomized controlled trials specifically on EBSE indicate three to five fold increases in employment rates and income (Drake et al., 1996, 1996b; Cook et al., 2005a, 2005b; Meisler & Williams, 1998).
On the other hand, 40%-60% do not obtain employment through EBSE. Possibly, EBSE provides effective services for individuals determined to locate employment; however, it lacks components to intervene with individuals demonstrating ambivalence about finding and maintaining work after they start EBSE. Employment outcomes may be related to perspectives on pros and cons of working rather than limitations of EBSE. Larson et al. (2007) described the ambivalence of individuals enrolled in EBSE; unemployed individuals reported 47 specific costs and benefits to work, Table 1, and employed individuals mentioned 25 distinct pros and cons, Table 2. These finding suggest the existence of ambivalence for individuals receiving EBSE, regardless of employment status. Furthermore, preliminary findings indicate a relationship between stages of change (pre-contemplation, contemplation, determination, action, maintenance, and relapse) and job offers, jobs obtained, and hourly wages (Larson, et al., In Press). In order to address these issues, employment practitioners may utilize Motivational Interviewing (MI), which has demonstrated effectiveness in resolving ambivalence and preparing individuals for goal and behavioral changes (Miller & Rollnick, 2002) across the stages of change. The primary purpose of this paper is to provide practitioners with a user-friendly intervention that integrates EBSE and MI into one service package.
Initially, we briefly define nine EBSE/MI methods and later in the paper we provide a discussion of how to apply these tools. The Intervention Matching Framework provides a model to match stage of change with either EBSE or MI, see Figure I. Practitioners utilize the Stages of Change Interview for Seeking Competitive Employment tool to identify an individual's stage of change related to employment, (See Appendix A). Motivational Interviewing offers a method to engage with individuals contemplating employment; MI assists individuals in preparing for life changes related to employment. Individuals unemployed for years may face ambivalence about their changing daily routine to fit the needs of employment; MI provides a mechanism for practitioners to address job ambivalence. Adapted from Miller and Rollnick (2002), the Costs and Benefits for Getting a Job tool assists practitioners in structuring a costs/benefits discussion with individuals identified as either pre-contemplating or contemplating employment, (See Appendix B). …