The paradox of multiple missions: An evaluability assessment of an affirmative business program that employs persons with serious mental illness.

摘要

Competitive employment among persons with histories of severe mental illness is exceptionally low (Anthony & Blanch, 1987). Mental disorders are ranked as the fifth most frequent cause of work limitation among chronic health conditions (Stoddard et al. 1998), and only persons with severe mobility impairments, persons who are blind, and persons with mental retardation are, on average, less likely to be employed than persons with severe mental disorders (Kaye & Longmore, 1997; Stoddard et al., 1998). Despite these poor statistics, vocational programs aimed at placing persons with severe mental illness in competitive employment, such as supported employment, show robust employment outcomes (Bond, Drake, Mueser, & Becker, 1997). An agency-sponsored affirmative business designed to competitively employ persons with severe mental illness and other barriers to employment was studied through a program evaluability assessment model. The literature on affirmative businesses, supported employment, and evaluability assessment were reviewed. Based on questions raised and developed by the intended users of the evaluability study, 47 stakeholders across 5 stakeholder groups were interviewed. Data gathered from these interviews were combined with reviews of program and corporate documentation and field observations, and a logic model was developed linking program resources, activities, persons served, and outcomes. A context assessment (Davis & Salasin, 1978) of the affirmative business was made. The affirmative business was compared with key principles of supported employment as an empirically supported benchmark for vocational treatment of persons with severe mental illness and poor employment histories. Results showed (a) that an affirmative business operating within the context of a nonprofit mental health services provider is highly complex, and (b) that the culture of the affirmative business may have a positive impact on persons served. Recommendations were made regarding the program, policy, and procedural development of the affirmative business, including outcome-based evaluation and business planning as means to guide the future of the affirmative business. Estimating the affirmative business's Social Return on Investment (Gair, 2002) was suggested as a way to demonstrate the unique value of this type of entity to mental health policy makers, along with the recommendation to replicate this apparently successful model of competitive employment.