title: Evaluation of a statewide implementation of supported employment in Massachusetts.
abstract: OBJECTIVE
  Randomized controlled trials (RCT) have shown supported employment (SE) to be an evidence-based practice (EBP) for people with psychiatric disabilities. Whether SE implemented under "real-world" conditions achieves outcomes comparable to RCTs is an important question for the psychiatric rehabilitation field. We examined employment outcomes achieved by SE programs in Massachusetts, and in particular examined whether fidelity to EBP standards was associated with outcomes.
  
  
  METHODS
  We examined outcomes for 3,474 clients served by 21 programs between 1997 and 2006, using multiple sources of data, including a client tracking database maintained by the SE programs as well as program site visits to assess fidelity to EBP standards. Using Generalized Estimating Equations, we modeled associations of client factors (demographics, diagnosis), program fidelity and other program factors to: (a) obtaining a job within 1 year of program enrollment; and among those obtaining jobs, (b) working 20 hours/week or more; and (c) earning $9/hr or more.
  
  
  RESULTS
  There were 51% of clients who obtained a job within 1 year of enrollment. Clients served by high fidelity programs were more likely to obtain jobs (OR = 1.45) and to work 20 hr/week or more (OR = 1.52); fidelity was unrelated to wages.
  
  
  CONCLUSIONS
  This study contributes to the evidence that real-world programs can implement SE with fidelity and achieve outcomes on par with those found in RCTs, and that fidelity makes a difference in the outcomes programs achieve. High fidelity programs may be most effective in helping clients acquire jobs and maximize the hours they work.
authors.affiliation: Center for Health Policy and Research.
authors.forename: Alexis D
authors.initials: AD
authors.lastname: Henry
authors.affiliation: Covidien, Ltd.
authors.forename: Lobat
authors.initials: L
authors.lastname: Hashemi
authors.affiliation: Center for Health Policy and Research.
authors.forename: Jianying
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016832:Employment, Supported / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D015397:Program Evaluation / Q000379:methods* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult