Integrated Scaling Approach: Developing a Model for Large Scale Implementation of Effective Interventions for Employment




Contact: Marianne Farkas

“Scaling up” evidence based practices (EBP) involves efforts to increase access to empirically supported in order to benefit more people over time (Simmons et al., 2007). The concept has been well-established in business and education but has had limited application to the field of employment of adults with psychiatric disabilities. This project is an effort to develop an innovative methodology to “scale up” employment interventions for individuals with psychiatric disabilities to address the 20 year “know-do” gap (W.H.O, 2005).

The most widely used EBP in the field of employment for individuals with psychiatric disabilities is supported employment (Bond et al., 2012; Corbière et al., 2011). However, the unemployment rate for adults living with mental illness continues to be three to five times higher than for those without mental illness (Burke-Miller, 2006; Marwaha et al., 2007). In addition, many participants in supported employment programs fail to meet their goals. Some of the major barriers that these individuals face are cognitive challenges and difficulty managing one’s illness while working (Catty et al., 2008; McGurk & Mueser, 2004; Razzano et al., 2005; Tsang et al., 2010). In order to deal with these challenges, EBPs like cognitive remediation, (e.g. “Thinking Skills for Work”: TSW; McGurk, et al., 2005, 2007, 2009) and training in “Vocational Illness Management Recovery” (VIMR; Farkas & Rogers, 2009) have been tested in previously funded NIDRR projects to enhance the effectiveness of supported employment. Despite having effective interventions to improve employment, it remains difficult to implement the widespread use of EBPs due to factors among others, such as 1) costly and time intensive training methods for providers to achieve competency levels (Lyon et al., 2011), 2) negative stakeholder attitudes towards work for people with psychiatric disabilities (Marwaha et al., 2009; Sainsbury Center, 2009) and, 3) the lack of knowledge about existing EBPs.

The purpose of the proposed project is to attend to the challenges of timely widespread implementation of EBPs by focusing on the two Development Stages (Proof of Concept and Proof of Product). Four goals serve to accomplish this: 1) establishing the conceptual elements of an innovative scaling approach (i.e. “Integrated Scaling Approach (ISA)” for employment interventions designed for people with psychiatric disabilities; 2) testing a working prototype for scaling up; 3) evaluating the resulting product and 4) transferring the technique for others to use in scaling up these and future employment interventions, through TDA activities. ISA is designed to be comprehensive, combining interactive technology and personal contact for the purpose of increasing the demand for and the supply of providers able to deliver new employment interventions. ISA will be iteratively developed, tested, refined and implemented, using expertise from multiple stakeholders with and without personal experience of psychiatric disabilities utilizing an emerging practice, VIMR, and an EBP, TSW. The approach will be created from the thorough collection and analysis of information from a systematic literature review, provider experiences and system key informants, concretized through a scalable implementation of these practices and evaluated by applying it to the EBP (TSW). The project outputs will include a systematic review of scaling literature; the scaling up of the two practices (VIMR, TSW); a Certificate program; two toolkits for use by advocates and agencies to promote positive messages about work for people with psychiatric disabilities; a handbook on ISA including a description and set of principles and lessons learned for scaling up such interventions; a preliminary evaluation of the approach itself at a state level and finally, the application of these learnings to other sites, states, providers and stakeholders. The outcomes will include better understanding of large scale implementation of new employment practices; more providers with increased skills in new employment practices across several states and more agencies with the capacity to embed such practices.

BU Center for Psychiatric Rehabilitation Staff Role
Marianne Farkas, Sc.D. Principal Investigator
Susan McGurk, Ph.D. Co-Principal Investigator
Kim Mueser, Ph.D.
David Blair, M.S.
Debbie Nicolellis
Joan Rapp, M.Ed.
Zlatka Russinova, Ph.D.
Philippe Bloch, M.Ed.


No documents are available at this time. Please use the project contact for specific inquiries.


Inquiries related to the project should be addressed to:

Marianne Farkas
Boston University, Center for Psychiatric Rehabilitation
940 Commonwealth Avenue West, 2nd Floor
Boston, MA 02215