How Does Outcome-Based Funding Affect Service Delivery? An Analysis of Consequences Within Employment Services for People Living With Serious Mental Illness

Abstract

This paper explores the impact of outcome-based funding on service delivery within employment services for people with serious mental illness. It draws on a case study of a policy change in the provincial disability support program in Ontario, Canada where funding for employment programs and services was changed from a fee-for-service to an outcome-based model. The findings highlight that the financial imperative for programs to meet employment targets in order to secure their funding has shifted the focus away from the provision of pre-employment supports to job development and job placements. However, there remains little attention to job matching and career development, and there is concern about access to services among those with complex barriers to employment. There is a need to reconcile tensions between the goals of outcome-based funding and on-the-ground service delivery to promote ongoing innovation in employment services for people with serious mental illness.

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Acknowledgments

This research was conducted as part of the requirements for a PhD in Rehabilitation Science at the University of Toronto. Funding was received from a Canadian Graduate Scholarship from the Social Sciences and Humanities Council (SSHRC) of Canada and the Canadian Occupational Therapy Foundation.

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Correspondence to Rebecca E. Gewurtz.

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Gewurtz, R.E., Cott, C., Rush, B. et al. How Does Outcome-Based Funding Affect Service Delivery? An Analysis of Consequences Within Employment Services for People Living With Serious Mental Illness. Adm Policy Ment Health 42, 19–28 (2015). https://doi.org/10.1007/s10488-014-0534-8

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Keywords

  • Employment services
  • Serious mental illness
  • Program funding
  • Outcome-based funding