Scaling Up Evidence-Based Supported Employment in the United States

Implementing evidence-based practices has become a standard policy in U.S. behavioral health care. However, current penetration remains inadequate, and longitudinal studies of scaling up these practices are rare. This article examined the steady, 3-decade growth of individual placement and support (IPS), the evidence-based model of employment services for people with psychiatric disabilities. The number of IPS programs in the United States has increased to >1,000. Nevertheless, coverage remains limited, and challenges to further growth are substantial. Facilitators of IPS growth over the past few decades include client demand, scientific evidence, initial financial support from foundations, subsequent federal agency support, state leadership in behavioral health and vocational rehabilitation, standardized training and quality assurance methods, an international learning community, and the collection of national data to establish benchmarks. Challenges to further expansion of IPS include the complexity of multiple partial funding sources; the increasing use of information technology for training, implementation, and quality assurance; extension to new populations and settings; outreach to historically marginalized groups (e.g., young adults not engaged in the mental health system); employer partnerships; and adaptations related to cultural, workforce, and workplace changes. Developing reliable research methods to assess and compare scaling-up strategies is also critical.