A scale to measure quality of supported employment for persons with severe mental illness

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Abstract
Objective}: Fidelity scales, which are instruments for measuring implementation of a program practice, are sorely needed as the mental health field increasingly moves toward adoption of evidence-based practices. We examined the psychometric properties of a new fidelity scale developed for assessing supported employment for people with severe mental illness. Study design: Telephone surveys were conducted in 5 states using the 33-item Quality of Supported Employment Implementation Scale (QSEIS) and the 15-item Individual Placement and Support (IPS) Fidelity Scale. We interviewed program directors for 144 vocational programs, including 106 supported employment programs and 38 programs offering vocational services other than supported employment. Results: Internal consistency for the total QSEIS was 0.72. For 27 (82%) of the QSEIS items, at least one-third of the supported employment sites were rated as fully implemented, suggesting concordance between the operating principles of supported employment as practiced in the field and the content of the QSEIS. Factor analysis yielded 5 interpretable factors: Job Placement, Integration with Mental Health Treatment, Long-Term Support, Teamwork, and Engagement. Supported employment differed from other vocational services, especially with respect to job placement in competitive employment and long-term support in these jobs. Concurrent validity was suggested by a 0.85 correlation between the QSEIS and the IPS Fidelity Scale. Conclusions: Fidelity scales are an essential component of an evidence-based practice. Surveys based on psychometrically adequate fidelity scales, such as the QSEIS, can foster greater understanding to the extent of implementation of such practices. For local, state, and national surveys of supported employment, it is incumbent that researchers and program planners use the QSEIS or instruments like it to describe vocational services.

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