The menu approach to employment services: Philosophy and five-year outcomes

The first part of this paper presents a vocational rehabilitation model for persons with severe and persistent psychiatric disabilities; the second part tests the model against 5-year outcomes. The Menu Approach to employment combines elements of other approaches under a new philosophical framework. The philosophy has four principles: (1) work offers many benefits besides a means to "pay the bills"; (2) virtually all consumers can participate in and benefit from meaningful paid work; (3) consumers should be able to choose from a "menu" of employment options, and; (4) multiple trials of different kinds of paid work are an important part of developing long-term employment in competitive settings. An empirical evaluation of the approach, analyzing 5 years of employment data form 102 participants in an ACT-based program, found 74% tried paid work, half working competitively; the average number of jobs was 3.6, with an overall average tenure of 19.8 months for all jobs combined; workers earned $561,000 over 5 years, averaging $2,054 per job; those working at competitive jobs earned more and worked more hours per weed than those working at jobs in agency-owned businesses. The Menu Approach offers the benefits of work to a much broader group of consumers with severe psychiatric disabilities than has been the case up until now.