Qualitative analysis of barriers to implementation of supported employment in the Department of Veterans Affairs.

OBJECTIVE: The aim of this qualitative study was to document perceived barriers to supported employment implementation as described by Department of Veterans Affairs (VA) employees.

METHODS: Interviews were conducted over two years at six VA medical centers involved in implementing supported employment, an evidence-based practice for helping people with serious mental illness obtain competitive employment. Eighty-four unique semistructured interviews focusing on program development were conducted at the two time points with 110 VA leaders, clinicians, and supported employment staff. A qualitative analysis was performed by using a hybrid of a priori coding categories (focused on organizational transformation) and a data-driven approach to examining perceived barriers to supported employment implementation.

RESULTS: Perceived barriers to supported employment implementation were most prominent during the first year of interviews. VA employees across the six sites reported challenges related to employees having paternalistic attitudes about individuals with serious mental illness and being uninformed about the supported employment program. They also reported a lack of organizational structures and leadership to educate providers, facilitate program integration with other teams, and promote the program's value. By the second year, most sites had addressed these challenges.

CONCLUSIONS: Paternalistic-uninformed concerns about the ability of persons with serious mental illness to be gainfully employed and a lack of organizational structures and leadership to promote and integrate the supported employment program were common implementation barriers. During implementation, organizations would likely benefit from a formalized educational process of teams involved in the care of supported employment clients and from leadership buy-in to the program and promotion of its significance.