TOWARDS ZERO EXCLUSION IN VOCATIONAL SERVICES FOR PERSONS WITH PSYCHIATRIC DISABILITIES - PREDICTION OF SERVICE RECEIPT IN A HYBRID VOCATIONAL CASE-MANAGEMENT SERVICE PROGRAM

Caught in the dilemma of too few vocational rehabilitation slots to se rve all interested consumers, agencies often have been accused of ''cr eaming''-offering vocational opportunities primarily to those with the greatest likelihood of employment success. Project WINS sought to imp lement a cost-effective method of enhancing vocational services to ind ividuals with severe mental illness served by mental health agencies, through the addition of vocational specialists (and other supports) to case management teams. The major principles guiding implementation ha d relevance for the process by which clients should receive vocational intervention: 1) toward zero exclusion of individuals from vocational services; 2) client self-determination of vocational goals, desires, and needs for service; and 3) the choose/get/keep model, tailoring int erventions to individual clients, whatever their stage of vocational d evelopment. Clients were referred to WINS primarily through case manag ers, although self-referrals were accepted. Predictive analyses (logis tic regression and survival analysis) identified variables that differ entiated clients who received services during the first 18 months of W INS operation from those who did not. Potential predictors came from f our domains: demographic and background characteristics; descriptors o f psychiatric status and community functioning; work history and expec tations; and agency setting variables. Results indicated that systemat ic client selection occurred: some elements of selection reflected the intervention's guiding principles, while other selection factors refl ected traditional labor market variables. Discussion includes applicat ion of findings to implementation of vocational interventions in menta l health case management agencies.