Abstract
Many people with complex behavioral health conditions are reluctant to access professional services, but little is known about providing outreach and assistance to this population. This report describes the process of delivering care in the Supported Employment Demonstration, a large Social Security Administration study that attempted to engage and provide services to such individuals. In the Supported Employment Demonstration, 60 multidisciplinary teams across the U.S. attempted to provide services and supports to nearly 2000 individuals identified by an initial denial of their disability claims based on a mental health impairment. Most of the participants were initially ambivalent toward or rejecting services. Four experienced quality monitors met with the teams monthly from 2017 through 2021, providing technical assistance and linking teams with consultants. The quality monitors, along with a larger implementation team of consultants, identified common challenges that clinical teams encountered while serving these participants and the strategies they used to overcome barriers. Participants presented with four common challenges: extreme poverty, hesitance to participate in services, complex medical and psychosocial conditions, and dangerous behaviors. To address these barriers, the teams assisted with basic needs, enhanced outreach efforts, accessed expert consultations, and reframed threatening behaviors as reactions to trauma. Many people with serious behavioral health conditions are reluctant to access professional services. These individuals may need help with basic needs, extensive outreach, consultations regarding multiple complex conditions, and professionals who understand their histories of trauma to enable their participation in standard behavioral health and vocational services.
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Funding
The Social Security Administration is funding the Supported Employment Demonstration (contract SS00-16–60014). The authors report no financial relationships with commercial interests. The Westat Institutional Review Board approved and monitored the study, in principles of the Declaration of Helsinki.
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SS provided technical assistance to teams, helped to analyze themes, and wrote the manuscript. JP provided technical assistance to teams and helped to analyze themes, and write the manuscript. DB supervised the technical assistance providers and helped to design the study, analyze themes, and write the manuscript. SL-Reese provided technical assistance to teams and helped to analyze themes, and write the manuscript. RB provided technical assistance to teams and helped to analyze themes, and write the manuscript. TS participated in the implementation team discussions and participated in conceptualizing and writing the article. RD was co-PI on the Supported Employment Demonstration, oversaw the implementation team, and participated in conceptualizing and writing the article.
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Swanson, S.J., Pogue, J.A., Becker, D.R. et al. Providing Team-Based Mental Health and Employment Services to Non-traditional Clients. J. Psychosoc. Rehabil. Ment. Health 11, 45–54 (2024). https://doi.org/10.1007/s40737-022-00321-4
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DOI: https://doi.org/10.1007/s40737-022-00321-4