Client-centeredness in supported employment: specialist and supervisor perspectives.
OBJECTIVE
This article examines the notion of client-centeredness from the perspective of supported employment specialists and supervisors, identifying barriers and facilitators to implementation in the field. Though by definition client-centered practices give precedence to clients' wishes, in a realistic setting client-centeredness is adapted to account for negotiations among clients, specialists, employers, and mental health service agencies.


METHODS
Qualitative interviews (n = 22) were conducted with employment specialists and supervisors to elicit facilitators and barriers to successful supported employment outcomes. Data were analyzed inductively using ATLAS.ti 5.0 software.


RESULTS
Principal factors influencing implementation of client-centeredness include (1) clients' anxieties about their interests and abilities, (2) difficulties interpreting and negotiating clients' preferences in realistic contexts, (3) quality of supervision and guidance in implementing client-centered practices and upholding morale when facing challenges in the field, and (4) managing discrepancies across resource-sharing agencies in what it means to be "client-centered".


CONCLUSIONS
These factors suggest the need for (1) focused training among employment specialists to better understand and negotiate clients' wishes, (2) more integration and communication between members of the treatment team, (3) hiring supervisors with first-hand supported employment experience, and (4) spreading awareness of the IPS model across resource-sharing agencies.
Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, CT 06034, USA.
Kristin M
KM
Kostick
Rob
R
Whitley
Philip W
PW
Bush
D000328:Adult; D001294:Attitude to Health; D016832:Employment, Supported / Q000379:methods*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D018802:Patient-Centered Care / Q000379:methods*; D013038:Specialization