Rehab Rounds: A Hybrid Transitional and Supported Employment Program

Introduction by the column editors: Given the recent emergence of supported employment as an evidence-based means of helping persons with mental illness obtain jobs in the competitive employment market, one might ask, "What is the value of and indications for transitional employment?" Because there is a group of persons with schizophrenia and other disabling mental disorders who may be reluctant to plunge directly into a commitment to undertake competitive work, alternative vocational rehabilitation services might increase the number of persons who can eventually graduate into the regular community workforce.This month's Rehab Rounds column describes a hybrid program that combines features of transitional and supported employment. Program participants are placed in real jobs in the community while both they and their employers are given a trial work period, of flexible duration, to decide on the feasibility of the individual's holding a position in which customary standards must be met. During the trial work period, the vocational rehabilitation program managers provide subsidies that reduce the salary expenses that must be met by the employer. The major advantage of these subsidies is that they make it possible to place clients into jobs quickly, harnessing their initial motivation and reducing their frustration and fears of failure. This aspect of the program is particularly important given that it usually takes about six months for even half the clients of a supported employment program to find work (1). However, the major disadvantage of the use of subsidies is that the transitional period of employment may become prolonged, with the client remaining dependent on transitional funding, fearful of moving into competitive employment, and reluctant to undertake a job search.The hybrid program described by Greig and colleagues represents a public-academic liaison with contributions from a Yale University research team, a local community mental health center, and the state vocational agency that provides the transitional work subsidies. In this program, subsidies have been used for as little as two weeks and for as long as a year to provide work opportunities to all clients who want to work, with the view that working promotes mental health and improves quality of life (2,3).