Effects of Practitioner Competency and Impact on Vocational Outcomes

This proposal is an evaluation of the competencies developed by community health workers through their participation in a vocational rehabilitation curriculum and the aggregate outcomes (employment, education) on a group of their clients over three time periods (before, during and 1 year after participation of the practitioners in the VR curriculum).

Employment and educational opportunities continue to remain elusive goals for persons with a serious mental illness. Community mental health providers agree that work and education are pivotal factors in the recovery process. However, such goals are rarely set, and rarely achieved by the client or the practitioner. "Among those with the most severe and complex mental health problems and illnesses, unemployment is estimated at between 70 and 90 per cent" (Latimer et al 2006). This is the highest rate among all disabilities.

Supported employment is an evidenced based practice, which has shown promising results by addressing many of the barriers to employment and education.. (Bond, 2004; Corbiere, et al 2005). Organizations that offer employment services strive to assist clients in obtaining and maintaining competitive employment. Yet, many staff are uncomfortable or unfamiliar with the very methods and protocols which have been shown to achieve this goal (Corbiere, et al 2010) In the evaluation of employment outcomes of a supported employment housing agency in New Jersey, team members identified lack of competency in vocational rehabilitation approaches as the biggest barrier to employment goals and outcomes (Van Houtte,(2010). From studies and reports, it seems clear that the main barrier encountered in mental health employment service delivery is lack of a workforce competent in evidence-based practice (Hoge, Morris \& Paris 2005; Taylor \& Bond, 2011).

A number of panels, consortia, and formal reports have indicated the need to improve the service delivery workforce in the mental health field, issuing various "calls for action" (Coursey et al., 2000; U.S. Surgeon General, 1999; New Freedom Commission on Mental Health, 2003; Hoge, et al., 2007; National Alliance for Mental Illness, 2006). The various bodies have consistently identified providers who uphold recovery-based values and attitudes as a critical factor in service delivery, especially in the vocational arena.

Canada's Mental Health Commission (CMHC) recently released 'The Mental Health Strategy of Canada - Changing Directions Changing Lives" (2012). The report specifically addresses rates of employment and human resources development. For example, strategic direction #3 from the CMHC document is to increase the rates of employment for people with mental illness. The recommendations for action 3.5 from the same report calls for enhanced supports for people living with mental health problems and illnesses to allow them to pursue education and obtain work. Strategic direction # 6 (CMHC, 2012) calls for strengthened human resources development. The corresponding recommendation for Action 6.2 and 6.3 seeks a pan-Canadian mental health workforce development strategy, including core competencies for all mental health service providers.

Competency has been defined as "a measurable capability that is required for effective performance" and is thought to be comprised of knowledge, skill and abilities and personal characteristics (Marelli, Tondora \& Hoge 2005). There has been some evidence to suggest that the specific education of providers result in improved employment outcomes for clients they serve in public systems including higher employment rates and better wages after the attainment of provider degree (Van Houtte 2010).

The purpose of most certification efforts is to populate a profession with practitioners who are not only competent but also recognized as being competent to provide the unique services central to those fields. Leahy and Szymanski (1993), writing about the field of rehabilitation counseling, assert that one profession is distinguished from others when common structures are present, including self-regulation, autonomy, and monopoly. These common structures include programs of educational preparation, professional associations, accreditation of educational programs, regulation of practice, certification and licensing, and ethical mandates. From this assertion, it would seem that credentialing is essential to professionalize a field; yet many experts argue that credentialing is of questionable significance when little research exists supporting positive impact on the delivery of services.

Such is the case with the Psycho-social Vocational Rehabilitation [PVR] curriculum developed by Boston University. The curriculum is competency-based due to its level of clinical application and formal supervision of practice. However, this certificate program has been delivered over the past 10 years with no formal evaluation. The intent of this proposed research project is to evaluate the competency of the community mental health practitioners (e.g., social workers, occupational therapists, psychiatric nurses) enrolled in the PVR certificate program and the vocational outcomes of the clients they provide services to within their organization.

Linking practitioner competency in vocational rehabilitation to the improvement seen in their clients of attaining goals (CMHC, 2012) around employment and education has an opportunity to inform on how the community mental health workforce should be trained for the future for the benefit of their clients.