Boston University Sargent College of Health & Rehabilitation Sciences
Center for Psychiatric Rehabilitation

Boston University Sargent College of Health & Rehabilitation Sciences
Center for Psychiatric Rehabilitation

Integrated Scaling Approach

Developing a Model for Large Scale Implementation of Effective Interventions for Employment




2016 - 2021


Marianne Farkas, Sc.D., Principal Investigator


“Scaling up” evidence-based practices (EBP) involves efforts to increase access to empirically supported services and treatment 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 with psychiatric disabilities continues to be three to five times higher than for those without psychiatric disabilities (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 symptoms 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 NIDILRR 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 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). The goals to accomplish this include establishing the conceptual elements of an innovative scaling approach (i.e. “Integrated Scaling Approach (ISA)” for employment interventions designed for people with psychiatric disabilities); testing a working prototype for scaling up; evaluating the resulting product and transferring the technique for others to use in scaling up these and future employment interventions, through TDA activities.

To date, the project has completed a scoping review of relevant literature in public health, mental health, business and education fields;  created a distance learning training program on the skills of VIMR and TSW; and created two toolkits for use by agencies to promote positive messages about work for people with psychiatric disabilities. Currently, we are testing the prototype for the ISA scaling approach with TSW in Oregon in 4 agencies in preparation for an evaluation study to be conducted in Georgia across 21 agencies. At the end of the project, a handbook on ISA including a description and set of principles and lessons learned for scaling up such interventions and the application of these learnings to other sites, states, providers and stakeholders is planned.

The outcomes will include a 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.



Principal Investigator: Marianne Farkas, Sc.D.
Co-Principal Investigator: Susan McGurk, Ph.D.

Project Staff

Kim Mueser, Ph.D.
Vasudha Gidugu, Ph.D.
Sigal Vax, Ph.D. (Cand.)
Chitra Khare, Ph.D. (Cand.)
Zlatka Russinova, Ph.D.
Philippe Bloch, M.Ed.


Inquiries related to the project should be addressed to:

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