Adapting Supported Employment for Emerging Adults with Serious Mental Health Conditions

  • Marsha L. EllisonEmail author
  • Vanessa V. Klodnick
  • Gary R. Bond
  • Izabela M. Krzos
  • Susan M. Kaiser
  • Marc A. Fagan
  • Maryann Davis


Effective services are needed to assist young people with serious mental health conditions to successfully transition to employment or education, especially among those with intensive adolescent mental health service utilization. To meet these needs, the Individual Placement and Support (IPS) model of supported employment was adapted and its feasibility was tested in a psychiatric treatment program for early-emerging adults. Participants were 17–20 years old (mean age = 18.5 years). Most were African American, under the custody of the state, with a primary mood disorder diagnosis. Adaptations to IPS included adding the following: near age peer mentors, a supported education component, and a career development focus. This open trial feasibility study tracked the model’s development, recruitment, and retention and tracked vocational and educational outcomes for 12 months. Model refinement resulted in the development of a separate educational specialist position, greater integration of the peer mentor with the vocational team, and further specification of the role of peer mentor. There was an 80% retention rate in the feasibility evaluation. Of the 35 participants, 49% started a job and/or enrolled in an education program over the 12-month period.


Serious Mental Illness Supplemental Security Income Serious Emotional Disturbance Adult Mental Health Service Vocational Development 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This research was supported by funding from the United States Department of Education, National Institute on Disability and Rehabilitation Research, and the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services (NIDRR grant H133B090018). Additional funding was provided by UMass Medical School’s Commonwealth Medicine division. The content does not necessarily reflect the views or policies of the funding agencies and you should not assume endorsement by the Federal Government.

Conflict of Interest

The authors do not have any conflicts of interest to report.


  1. 1.
    Davis M, Sheidow A, Zajac K., et al. Prevalence and impact of substance use among emerging adults with serious mental health conditions. Psychiatric Rehabilitation Journal 2013; 35(3):235–243.Google Scholar
  2. 2.
    Drake RE, Bond GR, Becker DR. Individual Placement and Support: An Evidence-Based Approach to Supported Employment. New York: Oxford University Press, 2012.CrossRefGoogle Scholar
  3. 3.
    Substance Abuse and Mental Health Services Administration. Working Definition of Recovery. Available online at Accessed July 16, 2014.
  4. 4.
    Arnett JJ. Emerging adulthood: a theory of development from the late teens through the twenties. American Psychologist 2000; 55(5):469–480.CrossRefPubMedGoogle Scholar
  5. 5.
    Breslau J, Lane M, Sampson N, et al. Mental disorders and subsequent educational attainment in a US national sample. Psychiatric Research 2008; 42(9):708–716.CrossRefGoogle Scholar
  6. 6.
    Reid R, Gonzalez JE, Nordness P, et al. A meta-analysis of the academic status of students with emotional/behavioral disturbance. The Journal of Special Education 2004; 38(3):130–143.CrossRefGoogle Scholar
  7. 7.
    Souma A, Rickerson N, Burgstahler S. Academic Accommodations for Students with Psychiatric Disabilities: Achieving Equal Access through Accommodations and Universal Design. DO-IT. University of Washington, 2006.Google Scholar
  8. 8.
    Lloyd C, Waghorn G. The importance of vocation in recovery for young people with psychiatric disabilities. The British Journal of Occupational Therapy 2007; 70(2):50–59.CrossRefGoogle Scholar
  9. 9.
    Wagner M, Newman L, Cameto R, et al. An overview of findings from wave 2 of the National Longitudinal Transition Study-2 (NLTS2). (NCSER 2006–3004). Menlo Park, CA: SRI International, 2006.Google Scholar
  10. 10.
    Newman L, Wagner M, Cameto R, et al. The Post-High School Outcomes of Youth With Disabilities up to 4 Years After High School. A Report from the National Longitudinal Transition Study-2 (NLTS2) (NCSER 2009–3017). Menlo Park, CA: SRI International, 2009.Google Scholar
  11. 11.
    Bond G, Xie H, Drake R. Can SSDI and SSI beneficiaries with mental illness benefit from evidence-based supported employment? Psychiatric Services 2007; 58(11):1412–1420.CrossRefPubMedGoogle Scholar
  12. 12.
    MacInnes, T, Tinson, A, Gaffney, D, et al. Disability, Long Term Conditions, and Poverty. London: New Policy Institute, 2014. Available online at Accessed July 16, 2014.
  13. 13.
    Davis M, Koroloff N, Ellison ML. Between adolescence and adulthood: rehabilitation research to improve services for youth and young adults. Psychiatric Rehabilitation Journal 2012; 35(3):167–170.CrossRefPubMedGoogle Scholar
  14. 14.
    Swanson SJ, Becker DR. IPS Supported Employment: A Practical Guide. Lebanon, NH: Dartmouth Psychiatric Research Center, 2013.Google Scholar
  15. 15.
    Bond GR, Drake RE. Making the case for IPS supported employment. Administration and Policy in Mental Health and Mental Health Services 2012; 39(6):419–502.CrossRefGoogle Scholar
  16. 16.
    Marshall T, Goldberg RW, Braude L, et al. Supported employment: assessing the evidence. Psychiatric Services 2014; 65(1):16–23.CrossRefPubMedGoogle Scholar
  17. 17.
    Burns T, Catty J, White S, et al. The impact of supported employment and working on clinical and social functioning: results of an international study of individual placement and support. Schizophrenia Bulletin 2009; 35(5):949–958.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Nuechterlein KH, Subotnik KL, Turner LR, et al. Individual placement and support for individuals with recent-onset schizophrenia: Integrating supported education and supported employment. Psychiatric Rehabilitation Journal 2008; 31:340–349.CrossRefPubMedGoogle Scholar
  19. 19.
    Clark HB, Unruh DK. Transition of Youth and Young Adults with Emotional or Behavioral Difficulties: An Evidence-Supported Handbook. Baltimore: Paul H. Brooks Publishing, 2009.Google Scholar
  20. 20.
    Becker DR, Swanson S, Bond GR, et al. Evidence-Based Supported Employment Fidelity Review Manual, Second Edition. Lebanon, NH: Dartmouth Psychiatric Research Center, 2011.Google Scholar
  21. 21.
    Rinaldi M, Killackey E, Smith J, et al. First episode psychosis and employment: a review. International Review of Psychiatry 2010; 22(2):148–162.CrossRefPubMedGoogle Scholar
  22. 22.
    Nuechterlein K, Subotnik K, Ventura J, et al. A randomized controlled trial of supported employment and education and workplace skills training in recent onset schizophrenia: notable improvements in work recovery. Schizophrenia Research 2008; 102/1–3(2):1– 279Google Scholar
  23. 23.
    Sumter SR, Bokhorst CL, Steinberg L, et al. The developmental pattern of resistance to peer influence in adolescence: will the teenager ever be able to resist? Journal of Adolescence 2009; 32(4):1009–1021.CrossRefPubMedGoogle Scholar
  24. 24.
    Flashman J. Different preferences or different opportunities? Explaining race differentials in the academic achievement of friends. Social Science Research 2012; 41(4):888–903.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Harris DN. How do school peers influence student educational outcomes? Theory and evidence from economics and other social sciences. Teachers College Record 2010; 112(4):1163–1197.Google Scholar
  26. 26.
    Ryabov I. Adolescent academic outcomes in school context: network effects reexamined. Journal of Adolescence 2011; 34(5):915–927.CrossRefPubMedGoogle Scholar
  27. 27.
    Felsman DE, Blustein DL. The role of peer relatedness in late adolescent career development. Journal of Vocational Behavior 1999; 54:279–295CrossRefGoogle Scholar
  28. 28.
    Sargent LD, Domberger SR. Exploring the development of a protean career orientation: values and image violations. The Career Development International 2007; 12(6):545–564.CrossRefGoogle Scholar
  29. 29.
    Hooley JM. Social factors in schizophrenia. Current Directions in Psychological Science 2010; 19(4):238–242.CrossRefGoogle Scholar
  30. 30.
    Oppenheimer CW, Hankin BL. Relationship quality and depressive symptoms among adolescents: a short-term multiwave investigation of longitudinal, reciprocal associations. Journal of Clinical Child Adolescent Psychology 2011; 40(3):486–493.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Davidson L, Chinman M, Sells D, et al. Peer support among adults with serious mental illness: a report from the field. Schizophrenia Bulletin 2006; 32(3):443–450.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Karcher MJ, Nakkula MJ. Play, Talk, Learn: Promising Practices in Youth Mentoring. New York: Wiley Periodicals, 2010.Google Scholar
  33. 33.
    Spencer R. Understanding the mentoring process between adolescents and adults. Youth & Society 2006; 37:287–315.CrossRefGoogle Scholar
  34. 34.
    Ahrens KR, DuBois DL, Richardson LP, et al. Youth in foster care with adult mentors during adolescence have improved adult outcomes. Pediatrics 2008, 121:e246-e252.CrossRefPubMedGoogle Scholar
  35. 35.
    Munson MR, McMillen JC. Natural mentoring and psychosocial outcomes among older youth transitioning from foster care. Children and Youth Services Review 2009; 31(1): 104–111.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Vorhies V, Davis KE, Frounfelker RL, et al. Applying social and cultural capital frameworks: understanding employment perspectives of transition age youth with serious mental health conditions. Journal of Behavioral Health Services & Research 2012; 39(3):257–270.CrossRefGoogle Scholar
  37. 37.
    Lent, RW, Brown SD, Hackett G. Toward a unifying social cognitive theory of career and academic interest, choice, and performance. Journal of Vocational Behavior 1994; 45(1):79–122.CrossRefGoogle Scholar
  38. 38.
    Bond GR, Salyers MP, Dincin J, et al. A randomized controlled trial comparing two vocational models for persons with severe mental illness. Journal of Consulting and Clinical Psychology 2007; 75,968-982.CrossRefPubMedGoogle Scholar
  39. 39.
    Substance Abuse and Mental Health Services Administration (SAMHSA). Supported Education: Building Your Program. HHS Pub. No. SMA-11-4654. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2011.Google Scholar
  40. 40.
    Wilkinson G. WRAT-3: Wide Range Achievement Test, Administration Manual. Wilmington, DE: Wide Range, Inc., 1993.Google Scholar
  41. 41.
    Bond GR, Peterson AE, Becker DR, et al. Validating the revised Individual Placement and Support Fidelity Scale (IPS-25). Psychiatric Services 2012; 63:758–763.CrossRefPubMedGoogle Scholar
  42. 42.
    Kim SJ, Bond GR. (in preparation). Individual Placement and Support Fidelity Scale (IPS-25) validation study.Google Scholar
  43. 43.
    McHugo GJ, Drake RE, Whitley R, et al. Fidelity outcomes in the National Implementing Evidence-Based Practices Project. Psychiatric Services 2007; 58:1279–1284.CrossRefPubMedGoogle Scholar
  44. 44.
    Rinaldi M, Perkins R, McNeil K, et al. The Individual Placement and Support approach to vocational rehabilitation for young people with first episode psychosis in the UK. Journal of Mental Health 2010; 9(6):483–91.CrossRefGoogle Scholar
  45. 45.
    Fetzer P, Garner T, Shelpler R, et al. Paving the Way for a New Day for Transition-Age Youth and Young Adults in Ohio’s Mental Health System, 2007. Available at: Accessed on June 16, 2014.
  46. 46.
    Lee D. Mental Health Services Act Innovative Programs. California Mental Health Services Oversight and Accountability Commission, 2012. Available online at Accessed June 16, 2014.
  47. 47.
    Munchel W. Some Tomato Soup for the TAY Provider’s Soul—Six Tips to Take Better Care of Ourselves. TAY Connection; 2012. Available online at six-tips-to-take-better-care-of-ourselves/. Accessed June 16, 2014.
  48. 48.
    Porteous N, Waghorn G. Developing evidence-based supported employment services for young adults receiving public mental health services. New Zealand Journal of Occupational Therapy 2009; 56(1):34–39.Google Scholar
  49. 49.
    Ferguson KM, Xie B, Glynn S. Adapting the individual placement and support model with homeless young adults. Child and Youth Care Forum 2012; 41:277–294.CrossRefGoogle Scholar
  50. 50.
    Davis M. Pioneering Transition Programs: The Establishment of Programs that Span the Ages Served by Child and Adult Mental Health. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 2007.Google Scholar
  51. 51.
    Bond GR, Drake, RE, Luciano A. Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review. Epidemiology and Psychiatric Sciences, 2014; First View Article:1–12.Google Scholar
  52. 52.
    Bond GR, Drake RE, Campbell K. The effectiveness of the Individual Placement and Support model of supported employment for young adults: results from four randomized controlled trials. Early Intervention in Psychiatry 2012; 6(1):30.CrossRefGoogle Scholar
  53. 53.
    Karasz, HN, Eiden A, Bogan S. Text messaging to communicate with public health audiences: how the HIPAA Security Rule affects practice. American Journal of Public Health 2013; 103(4):617–622.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© National Council for Behavioral Health 2014

Authors and Affiliations

  • Marsha L. Ellison
    • 1
    Email author
  • Vanessa V. Klodnick
    • 2
  • Gary R. Bond
    • 3
  • Izabela M. Krzos
    • 2
  • Susan M. Kaiser
    • 2
  • Marc A. Fagan
    • 4
  • Maryann Davis
    • 1
  1. 1.The Learning and Working During the Transition to Adulthood Rehabilitation Research and Training Center, Systems and Psychosocial Advances Research Center, Department of PsychiatryThe University of Massachusetts Medical SchoolShrewsburyUSA
  2. 2.Thresholds Research DepartmentChicagoUSA
  3. 3.Dartmouth Psychiatric Research Center, Department of PsychiatryGeisel School of Medicine at Dartmouth LebanonUSA
  4. 4.Thresholds Youth ProgramsChicagoUSA

Personalised recommendations