OBJECTIVE:

This study examined strategies and barriers for implementing supported employment in routine mental health services.

METHODS:

Qualitative and fidelity data from a two-year period (2002-2004) were examined for nine sites participating in the National Evidence-Based Practices Project.

RESULTS:

At baseline, none of the sites were providing high-fidelity supported employment. However, by the two-year follow-up, eight of the nine sites successfully implemented high-fidelity programs. Three factors, leadership, mastery, and attitudes, were identified as strongly influencing the implementation (both positively and negatively) across the nine sites.

CONCLUSIONS:

The findings indicate the need for strong leadership on both the administrative and program levels, an in-depth understanding of the nature and level of training and consultation needed for program leaders and employment specialists, and the value of hiring staff with clinical or business skills. The study also demonstrated that employing staff who doubt and challenge the evidence-based model slows down the implementation process, suggesting the critical role of hiring staff who believe in recovery and supported employment principles.