A man with severe mental illness has difficulty with boredom, feels that attending the day program does not challenge him, and wishes to earn money. Which of the following options would be most appropriate for addressing these issues?

Question

a. Involve him in volunteer work at the consumer-run clubhouse program at the mental health center.
b. Help the patient apply for services at the state's Bureau of Vocational Rehabilitation.
c. Rapidly pace him in a competitive job of his choosing, accompanied by a coach on the job site.
d. First involve the patient in prevocational training, then in employment in a sheltered workshop.

Answer 1

C
The option associated with the greatest likelihood of achieving successful, sustained competitive employment is the supported employment model, which involves rapidly placing the patient in a competitive employment position, accompanied by on-site job coaching and support that coordinates with the employer to provide needed support and on-the-job training. Contrasted to volunteer work, competitive employment would be more challenging and provide income. Placing the patient in the job first, then giving individualized training and coaching support in the field describes the supported employment model that is now an evidence-based practice. Research has not supported the Bureau of Vocational Rehabilitation model, which involves prevocational training followed by sheltered employment before moving on to competitive employment. Clubhouse programs are helpful for many patients but do not have as high a success rate for achieving competitive employment.