Affiliations: Institute for Treatment and Services Research at
National Development and Research Institutes, New York, NY, USA | The National Association on Drug Abuse Problems, New
York, NY, USA
Note: [] Address for correspondence: Dr. Staines, 321 North Fourth
Avenue, Highland Park, NJ 08904, USA. Tel.: +1 732 745 9272; Fax: +1 732
7459272; E-mail: glstaines@aol.com
Abstract: Few methadone-maintained patients are employed, due to personal
barriers and limited vocational services. With federal and state policy reforms
compelling substance users to obtain work or risk losing public benefits, it is
imperative to develop and test innovative vocational rehabilitation models.
Designed for methadone patients, the Customized Employment Supports (CES) model
integrates components of traditional vocational counseling in treatment,
innovative vocational programs for the severely mentally ill, and case
management techniques. This paper describes CES, its principles, essential
elements, and stages of service delivery. The model features a small
caseload [16], long service duration (up to 18 months), frequent
counselor-patient contacts, fieldwork with patients, and rapid job search.
Although the primary goal of CES is competitive employment, incremental and
intermediate steps involving any productive activity are also valued. After
establishing a working alliance, the CES counselor helps patients increase
their self-efficacy, and addresses both vocational and non-vocational barriers
to employment. The CES model may also contribute to non-vocational
improvements, especially reductions in illicit drug use, excessive alcohol
consumption, and criminality. The CES model has been implemented at two urban
methadone-maintenance clinics as part of a five-year randomized clinical trial
to test the model's efficacy by comparing it with standard vocational
services.
