Affiliations: Department of Psychology, Indiana University-Purdue
University Indianapolis, Indianapolis, IN, USA | Supported Employment Consultation and Training
Center
Note: [] Address for correspondence: John H. McGrew, Department of
Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN
46202, USA. Tel.: +1 317 274 8672; Fax: +1 317 274 6756; E-mail:
jmcgrew@iupui.edu
Abstract: Background. To help mitigate empirically-identified shortcomings in
Supported Employment (SE) outcomes for consumers with severe mental illness in
Indiana (e.g., few long-term placements), Vocational Rehabilitation Services
(VRS) and the Indiana Division of Mental Health and Addictions (DMHA) proposed
the implementation of a results-based funding (RBF) system, in which providers
received payment only when clients successfully attained each of 5 employment
milestones. The current study presents the results of a multi-site controlled
trial of RBF vs. a traditional fee-for-service (FFS) model. Method. The sample included 122 (RBF=81, FFS=41) consumers of SE
(52% schizophrenia, 35% mood disorder). Assessments of clinical and life
outcomes were conducted quarterly across 12 months. Results. Those served in RBF were more likely to attain all
milestones collectively, and to have a completed person-centered plan and
attain 9-months of employment, specifically. There were few differences between
those in RBF and FFS on non-milestone employment variables (e.g., job match,
wages) or clinical measures (e.g., quality of life, functioning). Conclusions. RBF produces better overall vocational outcomes,
specifically, higher rates of completion of a person-centered plan and
retention of employment for 9 months. However, improvements with RBF were
limited to those specified and did not generalize to vocational areas not
targeted by the milestones (e.g., wages, benefits) or to changes in other life
domains typically valued by psychiatric rehabilitation.
Keywords: Supported employment, vocational rehabilitation, performance based contracting, severe mental illness, treatment outcomes
