BACKGROUND/RATIONALE:
A stated goal of Mental Health QUERI is to "implement evidence-based psychosocial rehabilitation guidelines for schizophrenia," including supported employment (SE; Mental Health QUERI, 2004). Although there have been great strides in developing evidence-based practices for people with severe mental illness such as SE (Drake et al., 2001), the research on dissemination and implementation has lagged behind, creating a gap between research and practice. The current project will help to identify factors that promote successful implementation of SE for people with severe mental illness. The project is a collaboration between Mental Health QUERI, the Northeast Program Evaluation Center, the Center for Organization, Leadership, and Management Research; and the Office of Psychosocial Rehabilitation in VA Central Office (VACO), and aims to use both quantitative and qualitative methods to study the national implementation of SE.

OBJECTIVE(S):
This project aims to use both quantitative and qualitative methods to study the national implementation of SE. Specifically, the project aims to: (1) Evaluate the implementation of SE across 21 VA Medical Centers, one in each VISN; (2) Identify factors that facilitate the successful dissemination and implementation of SE; (3) Examine the relationship between SE implementation fidelity and effectiveness; (4) Explore the role of administrative support in successful program implementation.

METHODS:
The primary intervention of interest in this proposal is the training, supervision, and monitoring process designed to disseminate SE to each VISN in VHA. We are comparing the effectiveness of two models of training. All 21 sites will receive basic training, which will consist of an initial site visit, fidelity ratings and feedback every six months, and provision of manuals and workbooks. The intensive sites will receive multidimensional training with frequent and individualized feedback. In this project we are analyzing the administrative data collected during the implementation period and performing an in-depth qualitative study of the administrative and organizational factors that influence successful implementation.


FINDINGS/RESULTS:
Analyses are underway and findings should be available in late 2008.

IMPACT:
The VHA Action Agenda challenges VHA to "commit to recovery-based. mental health programs" and "evidence based interventions to promote the highest quality of care (Murphy et al., 2003)." This type of widespread culture change requires a multidimensional approach, both in the communication of new ideas and philosophies, as well as specific behaviors. SE is in many ways the ideal best practice to introduce into a system to affect the kind of transformation. SE is a well-defined intervention with extensive evidence to support its effectiveness. Further, it is philosophically aligned with the goals of a recovery-oriented service system (Resnick, Rosenheck, & Lehman, 2004). The project proposed here will provide documentation of the implementation of SE across the VA system, as well as evaluate the strategies employed to foster successful implementation, allowing for the identification of strategies to continue to translate the Secretary and Under Secretary's vision of the VA mental health system into reality. The proposed project also will significantly contribute to the research base on translating efficacious interventions into routine practice. The size of the VHA system provides a tremendous opportunity to examine a system transformation on a very large scale. An effectiveness study such as this, conducted under "real world" conditions, will add to our understanding of organizational and provider factors that contribute to successful implementation. Further, examining differences in implementation across sites receiving different levels and types of training will help to disentangle which training components are most effective in changing provider behavior.

---

External Links for this Project

---

PUBLICATIONS:

Journal Articles

1. Resnick SG, Rosenheck R. Dissemination of supported employment in Department of Veterans Affairs. Journal of rehabilitation research and development. 2007 Jan 1; 44(6):867-77. [view]
2. Resnick SG, Rosenheck RA, Canive JM, De Souza C, Stroup TS, McEvoy J, Davis S, Keefe RS, Swartz M, Lieberman J. Employment outcomes in a randomized trial of second-generation antipsychotics and perphenazine in the treatment of individuals with schizophrenia. The journal of behavioral health services & research. 2008 Apr 1; 35(2):215-25. [view]
3. Barber JA, Rosenheck RA, Armstrong M, Resnick SG. Monitoring the dissemination of peer support in the VA Healthcare System. Community mental health journal. 2008 Dec 1; 44(6):433-41. [view]
4. Resnick SG, Rosenheck RA. Posttraumatic stress disorder and employment in veterans participating in Veterans Health Administration Compensated Work Therapy. Journal of rehabilitation research and development. 2008 Jan 1; 45(3):427-35. [view]
5. Resnick SG, Rosenheck RA. Recovery and positive psychology: parallel themes and potential synergies. Psychiatric services (Washington, D.C.). 2006 Jan 1; 57(1):120-2. [view]
6. Resnick G., Rosenheck, Drebing. What makes vocational rehabilitation effective?: Program characteristics versus employment outcomes. Psychological Services. 2006 Feb 1; 3:239-248. [view]

Conference Presentations

1. Lerner BN, Maule AL, VanDeusen-Lukas C, Cramer IE, Shwartz M, Charns MP. Transformational Change in Health Care: Validation of a Model. Poster session presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL. [view]

DRA: Mental, Cognitive and Behavioral Disorders, Health Systems Science
DRE: none
Keywords: Implementation, Severe mental illness
MeSH Terms: none